Provider Demographics
NPI:1225373103
Name:PRINCETON FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:PRINCETON FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-924-4469
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-1494
Mailing Address - Country:US
Mailing Address - Phone:609-924-4469
Mailing Address - Fax:609-228-6666
Practice Address - Street 1:66 MOUNT LUCAS RD
Practice Address - Street 2:SUITE E2
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2733
Practice Address - Country:US
Practice Address - Phone:609-924-4469
Practice Address - Fax:609-228-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU32141Medicare UPIN
NJ030337Medicare PIN