Provider Demographics
NPI:1275550774
Name:THE NECK & BACK TREATMENT CENTER, INC
Entity Type:Organization
Organization Name:THE NECK & BACK TREATMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENCIVENGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-587-1881
Mailing Address - Street 1:1670 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3710
Mailing Address - Country:US
Mailing Address - Phone:609-587-1881
Mailing Address - Fax:609-587-6957
Practice Address - Street 1:1670 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3710
Practice Address - Country:US
Practice Address - Phone:609-587-1881
Practice Address - Fax:609-587-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2247672OtherAETNA
NJ1875809Medicaid
NJ2247672OtherAETNA
NJ=========OtherTAX ID