Provider Demographics
NPI:1417271982
Name:AFFILIATED SPORTS CLINIC, P.C.
Entity Type:Organization
Organization Name:AFFILIATED SPORTS CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CHESNAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-642-0300
Mailing Address - Street 1:9-25 ALLING STREET
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102
Mailing Address - Country:US
Mailing Address - Phone:973-642-0300
Mailing Address - Fax:973-642-0302
Practice Address - Street 1:9-25 ALLING STREET
Practice Address - Street 2:SUITE # 101
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-642-0300
Practice Address - Fax:973-642-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00241200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty