Provider Demographics
NPI:1174651798
Name:LAFFERTY CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:LAFFERTY CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:732-901-5033
Mailing Address - Street 1:217 GRANDE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1119
Mailing Address - Country:US
Mailing Address - Phone:609-929-4181
Mailing Address - Fax:732-797-0333
Practice Address - Street 1:147 ROUTE 70
Practice Address - Street 2:SUITE 10
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-0973
Practice Address - Country:US
Practice Address - Phone:732-901-5033
Practice Address - Fax:732-901-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00608500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV01387Medicare UPIN