Provider Demographics
NPI:1275704793
Name:BOONTON CHIROPRACTIC HEALTH CENTER P.C.
Entity Type:Organization
Organization Name:BOONTON CHIROPRACTIC HEALTH CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-335-5400
Mailing Address - Street 1:117 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1709
Mailing Address - Country:US
Mailing Address - Phone:973-335-5400
Mailing Address - Fax:973-335-9194
Practice Address - Street 1:117 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1709
Practice Address - Country:US
Practice Address - Phone:973-335-5400
Practice Address - Fax:973-335-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO2777111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44962Medicare UPIN