Provider Demographics
NPI:1124410782
Name:CHIROPRACTIC CENTER OF MONMOUTH
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF MONMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LACOGNATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCIC
Authorized Official - Phone:732-441-9898
Mailing Address - Street 1:1055 ROUTE 34 STE B
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2192
Mailing Address - Country:US
Mailing Address - Phone:732-441-9898
Mailing Address - Fax:732-441-9555
Practice Address - Street 1:1055 ROUTE 34 STE B
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2192
Practice Address - Country:US
Practice Address - Phone:732-441-9898
Practice Address - Fax:732-441-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00470000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1811949233Medicare Oscar/Certification
NJ1811949233Medicare UPIN
NJ1811949233Medicare PIN
NJ1811949233Medicare NSC