Provider Demographics
NPI:1376852798
Name:PASSAIC FAMILOY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:PASSAIC FAMILOY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADDESA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-928-4010
Mailing Address - Street 1:385 LAKEVIEW AVE., SUITE 4
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4074
Mailing Address - Country:US
Mailing Address - Phone:973-928-4010
Mailing Address - Fax:973-928-4012
Practice Address - Street 1:385 LAKEVIEW AVE., SUITE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4074
Practice Address - Country:US
Practice Address - Phone:973-928-4010
Practice Address - Fax:973-928-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00467000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty