Provider Demographics
NPI:1326438094
Name:COMPASS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COMPASS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:OMULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-588-0963
Mailing Address - Street 1:3100 BRIDGE AVE
Mailing Address - Street 2:OFFICE #3
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3472
Mailing Address - Country:US
Mailing Address - Phone:714-588-0963
Mailing Address - Fax:
Practice Address - Street 1:3100 BRIDGE AVE
Practice Address - Street 2:OFFICE #3
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3472
Practice Address - Country:US
Practice Address - Phone:714-588-0963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty