Provider Demographics
NPI:1366455115
Name:SEAPORT CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SEAPORT CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PAGNOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-294-5808
Mailing Address - Street 1:593 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1805
Mailing Address - Country:US
Mailing Address - Phone:609-294-5808
Mailing Address - Fax:609-294-5809
Practice Address - Street 1:593 RADIO RD
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08087-1805
Practice Address - Country:US
Practice Address - Phone:609-294-5808
Practice Address - Fax:609-294-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty