Provider Demographics
NPI:1235319799
Name:POMPTON CHIROPRACTIC AND ATHLETIC TRAUMA CENTER, PA
Entity Type:Organization
Organization Name:POMPTON CHIROPRACTIC AND ATHLETIC TRAUMA CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:B RUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-239-1119
Mailing Address - Street 1:6 POMPTON AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2042
Mailing Address - Country:US
Mailing Address - Phone:973-239-1119
Mailing Address - Fax:
Practice Address - Street 1:6 POMPTON AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2042
Practice Address - Country:US
Practice Address - Phone:973-239-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ453315Medicare PIN