Provider Demographics
NPI:1376758441
Name:CHIROPRACTIC & REHABILITATION CENTER PC
Entity Type:Organization
Organization Name:CHIROPRACTIC & REHABILITATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVOLO-SCLAFANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-955-0755
Mailing Address - Street 1:517 RIVER DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3270
Mailing Address - Country:US
Mailing Address - Phone:973-955-0755
Mailing Address - Fax:973-955-0753
Practice Address - Street 1:517 RIVER DR STE 2A
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3270
Practice Address - Country:US
Practice Address - Phone:973-955-0755
Practice Address - Fax:973-955-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00505700111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty