Provider Demographics
NPI:1215395132
Name:PRIME SPINECARE
Entity Type:Organization
Organization Name:PRIME SPINECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-482-0439
Mailing Address - Street 1:118 BROAD AVE STE N9
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2721
Mailing Address - Country:US
Mailing Address - Phone:201-482-0439
Mailing Address - Fax:201-482-8703
Practice Address - Street 1:118 BROAD AVE STE N9
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-2721
Practice Address - Country:US
Practice Address - Phone:201-482-0439
Practice Address - Fax:201-482-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00733100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty