Provider Demographics
NPI:1376829382
Name:MERCER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:MERCER FAMILY CHIROPRACTIC
Other - Org Name:CIVINSKI CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:CIVINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-631-7200
Mailing Address - Street 1:3105 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1844
Mailing Address - Country:US
Mailing Address - Phone:609-631-7200
Mailing Address - Fax:609-631-9363
Practice Address - Street 1:3105 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1844
Practice Address - Country:US
Practice Address - Phone:609-631-7200
Practice Address - Fax:609-631-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00516500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067831Medicare PIN
NJU94248Medicare UPIN