Provider Demographics
NPI:1225102965
Name:CORRECTIVE CARE GROUP PC
Entity Type:Organization
Organization Name:CORRECTIVE CARE GROUP PC
Other - Org Name:MIDSTATE CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-613-6000
Mailing Address - Street 1:67 WEST PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2118
Mailing Address - Country:US
Mailing Address - Phone:732-613-6000
Mailing Address - Fax:732-613-6007
Practice Address - Street 1:67 WEST PROSPECT ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2118
Practice Address - Country:US
Practice Address - Phone:732-613-6000
Practice Address - Fax:732-613-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 225100000X
NJ46TR00414100225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6384030001Medicare NSC