Provider Demographics
NPI:1376589259
Name:950 CROSS, LLC
Entity Type:Organization
Organization Name:950 CROSS, LLC
Other - Org Name:C. M. CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BIRDSALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-772-6300
Mailing Address - Street 1:1 BRITTON PLACE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2514
Mailing Address - Country:US
Mailing Address - Phone:856-772-6300
Mailing Address - Fax:856-772-4931
Practice Address - Street 1:1 BRITTON PLACE
Practice Address - Street 2:SUITE 10
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2514
Practice Address - Country:US
Practice Address - Phone:856-772-6300
Practice Address - Fax:856-772-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00635900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2785881000OtherAMERIHEALTH IBC
NJV10152Medicare UPIN
NJ103656Medicare ID - Type Unspecified