Provider Demographics
NPI:1194043604
Name:AVON CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:AVON CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-988-8596
Mailing Address - Street 1:516 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:AVON BY THE SEA
Mailing Address - State:NJ
Mailing Address - Zip Code:07717-1155
Mailing Address - Country:US
Mailing Address - Phone:732-988-8596
Mailing Address - Fax:
Practice Address - Street 1:516 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:AVON BY THE SEA
Practice Address - State:NJ
Practice Address - Zip Code:07717-1155
Practice Address - Country:US
Practice Address - Phone:732-988-8596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00341500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty