Provider Demographics
NPI:1285689208
Name:WINTERBOTTOM FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WINTERBOTTOM FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERBOTTOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-625-2006
Mailing Address - Street 1:5429 HARDING HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2203
Mailing Address - Country:US
Mailing Address - Phone:609-625-2006
Mailing Address - Fax:609-625-1995
Practice Address - Street 1:5429 HARDING HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2203
Practice Address - Country:US
Practice Address - Phone:609-625-2006
Practice Address - Fax:609-625-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00567700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2407163000OtherAMERIHEALTH
NJ3957923OtherAETNA
NJ3957923OtherAETNA
NJ=========OtherHORIZON BLUE CROSS BLUE S