Provider Demographics
NPI:1235177130
Name:GACCIONE CHIROPRACTIC CTR PA
Entity Type:Organization
Organization Name:GACCIONE CHIROPRACTIC CTR PA
Other - Org Name:CLINTON STREET CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GACCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-624-4000
Mailing Address - Street 1:PO BOX 43508
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:973-624-4000
Mailing Address - Fax:973-624-1212
Practice Address - Street 1:26 CLINTON STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-624-4000
Practice Address - Fax:973-624-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty