Provider Demographics
NPI:1427590827
Name:CILLO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CILLO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:CILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-228-0019
Mailing Address - Street 1:10 WOODLANE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-228-0019
Mailing Address - Fax:856-228-7992
Practice Address - Street 1:10 WOODLANE DRIVE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-228-0019
Practice Address - Fax:856-228-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00495200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty