Provider Demographics
NPI:1376765602
Name:ACADEMY TOTAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:ACADEMY TOTAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CINTINEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-796-7772
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1097
Mailing Address - Country:US
Mailing Address - Phone:201-796-7772
Mailing Address - Fax:201-794-8818
Practice Address - Street 1:19-21 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-796-7772
Practice Address - Fax:201-794-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC003095111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072431Medicare ID - Type UnspecifiedGROUP ID