Provider Demographics
NPI:1235304932
Name:STALLONE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:STALLONE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:STALLONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-665-8000
Mailing Address - Street 1:134 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1101
Mailing Address - Country:US
Mailing Address - Phone:908-665-8000
Mailing Address - Fax:908-665-4090
Practice Address - Street 1:134 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1101
Practice Address - Country:US
Practice Address - Phone:908-665-8000
Practice Address - Fax:908-665-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ535934Medicare PIN