Provider Demographics
NPI:1407119811
Name:SPECIFIC CHIROPRACTIC CLINICS OF NJ, INC
Entity Type:Organization
Organization Name:SPECIFIC CHIROPRACTIC CLINICS OF NJ, INC
Other - Org Name:SHORE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-223-8888
Mailing Address - Street 1:2640 HIGHWAY 70
Mailing Address - Street 2:BUILDING 8, SUITE 201
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2609
Mailing Address - Country:US
Mailing Address - Phone:732-223-8888
Mailing Address - Fax:
Practice Address - Street 1:2640 HIGHWAY 70
Practice Address - Street 2:BUILDING 8, SUITE 201
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:732-223-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty