Provider Demographics
NPI:1164712659
Name:DIPOCE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DIPOCE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIPOCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-920-9522
Mailing Address - Street 1:35 BEAVERSON BOULEVARD
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-920-9522
Mailing Address - Fax:732-920-3022
Practice Address - Street 1:35 BEAVERSON BOULEVARD
Practice Address - Street 2:SUITE 7A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-920-9522
Practice Address - Fax:732-920-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87638Medicare UPIN
DI561689Medicare PIN