Provider Demographics
NPI:1376761213
Name:CHIRO-ROW HEALTH CONSORTIUM, LLC
Entity Type:Organization
Organization Name:CHIRO-ROW HEALTH CONSORTIUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:862-452-0031
Mailing Address - Street 1:413 WASHINGTON AVE
Mailing Address - Street 2:PO BOX 692
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2618
Mailing Address - Country:US
Mailing Address - Phone:862-452-0031
Mailing Address - Fax:
Practice Address - Street 1:123 MILLIGAN PL
Practice Address - Street 2:A-3
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1928
Practice Address - Country:US
Practice Address - Phone:862-452-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC005961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV04166Medicare ID - Type UnspecifiedMEDICARE