Provider Demographics
NPI:1366627630
Name:QUANTUM CHIROPRACTIC HOLISTIC CENTER PC
Entity Type:Organization
Organization Name:QUANTUM CHIROPRACTIC HOLISTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-878-6945
Mailing Address - Street 1:PO BOX 55011
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-6011
Mailing Address - Country:US
Mailing Address - Phone:908-222-7400
Mailing Address - Fax:
Practice Address - Street 1:1314 GEORGE ST
Practice Address - Street 2:STE B
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-1748
Practice Address - Country:US
Practice Address - Phone:908-222-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00504900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7243600Medicaid
NJ7243600Medicaid