Provider Demographics
NPI:1265820559
Name:PRINCETON CHIROPRACTIC AND SPORTS REHAB, LLC
Entity Type:Organization
Organization Name:PRINCETON CHIROPRACTIC AND SPORTS REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-921-1705
Mailing Address - Street 1:601 EWING ST STE C3
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2756
Mailing Address - Country:US
Mailing Address - Phone:609-921-1705
Mailing Address - Fax:
Practice Address - Street 1:601 EWING ST STE C3
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2756
Practice Address - Country:US
Practice Address - Phone:609-921-1705
Practice Address - Fax:609-921-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00374900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty