Provider Demographics
NPI:1154835734
Name:ESPORTS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ESPORTS HEALTHCARE, LLC
Other - Org Name:DR. COREY J. CSAKAI, CSCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CSAKAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-692-3460
Mailing Address - Street 1:210 E FLAMINGO RD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4797
Mailing Address - Country:US
Mailing Address - Phone:908-692-3460
Mailing Address - Fax:
Practice Address - Street 1:1356 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3088
Practice Address - Country:US
Practice Address - Phone:732-444-8114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00736700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00736700OtherLICENSE