Provider Demographics
NPI:1235671363
Name:PEAK CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:PEAK CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:862-237-7801
Mailing Address - Street 1:411 CHESTNUT ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2499
Mailing Address - Country:US
Mailing Address - Phone:862-237-7801
Mailing Address - Fax:862-237-7803
Practice Address - Street 1:411 CHESTNUT ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2499
Practice Address - Country:US
Practice Address - Phone:862-237-7801
Practice Address - Fax:862-237-7803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK CHIROPRACTIC & WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00697700111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty