Provider Demographics
NPI:1174816243
Name:WHARFSIDE CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:WHARFSIDE CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGILLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-971-7733
Mailing Address - Street 1:2 HOLLYWOOD BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4839
Mailing Address - Country:US
Mailing Address - Phone:609-971-7733
Mailing Address - Fax:609-693-7623
Practice Address - Street 1:2 HOLLYWOOD BLVD
Practice Address - Street 2:STE. A
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4839
Practice Address - Country:US
Practice Address - Phone:609-971-7733
Practice Address - Fax:609-693-7623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00317300261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45646Medicare UPIN