Provider Demographics
NPI:1124203443
Name:PAUL FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:PAUL FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-924-5678
Mailing Address - Street 1:1 AIRPORT PL
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1532
Mailing Address - Country:US
Mailing Address - Phone:609-924-5678
Mailing Address - Fax:609-924-5652
Practice Address - Street 1:1 AIRPORT PL
Practice Address - Street 2:SUITE # 4
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1532
Practice Address - Country:US
Practice Address - Phone:609-924-5678
Practice Address - Fax:609-924-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC004998111N00000X
NJ38MC006069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069737RRJMedicare PIN
NJ815934RRJMedicare PIN
NJ069732Medicare PIN