Provider Demographics
NPI:1417040106
Name:IDEAL CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:IDEAL CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NAJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-303-0338
Mailing Address - Street 1:2224 ROUTE 9 SO.
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3333
Mailing Address - Country:US
Mailing Address - Phone:732-303-0338
Mailing Address - Fax:732-303-8520
Practice Address - Street 1:2224 ROUTE 9 SO.
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3333
Practice Address - Country:US
Practice Address - Phone:732-303-0338
Practice Address - Fax:732-303-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00373100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU10483Medicare UPIN
NJNA611332Medicare PIN