Provider Demographics
NPI:1124215355
Name:RIVER VALE CHIROPRACTIC CENTER P. A.
Entity Type:Organization
Organization Name:RIVER VALE CHIROPRACTIC CENTER P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-666-5300
Mailing Address - Street 1:674 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6307
Mailing Address - Country:US
Mailing Address - Phone:201-666-5300
Mailing Address - Fax:201-666-4951
Practice Address - Street 1:674 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6307
Practice Address - Country:US
Practice Address - Phone:201-666-5300
Practice Address - Fax:201-666-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty