Provider Demographics
NPI:1326307307
Name:SUCCASUNNA CHIROPRACTIC AND SPINE REHAB
Entity Type:Organization
Organization Name:SUCCASUNNA CHIROPRACTIC AND SPINE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-584-4420
Mailing Address - Street 1:225 ROUTE 10 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1300
Mailing Address - Country:US
Mailing Address - Phone:973-584-4420
Mailing Address - Fax:
Practice Address - Street 1:225 ROUTE 10 E
Practice Address - Street 2:SUITE 101
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1300
Practice Address - Country:US
Practice Address - Phone:973-584-4420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00697100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty