Provider Demographics
NPI:1417130576
Name:IKEDA FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:IKEDA FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:IKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-298-7700
Mailing Address - Street 1:23659 COLUMBIA ROAD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1979
Mailing Address - Country:US
Mailing Address - Phone:609-298-7700
Mailing Address - Fax:609-298-7724
Practice Address - Street 1:23659 COLUMBUS RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1980
Practice Address - Country:US
Practice Address - Phone:609-298-7700
Practice Address - Fax:609-298-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00530400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2269303000OtherHORIZON BLUE CROSS
NJ074228Medicare PIN