Provider Demographics
NPI:1457473282
Name:AVENEL FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:AVENEL FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-636-7813
Mailing Address - Street 1:245 AVENEL ST
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1433
Mailing Address - Country:US
Mailing Address - Phone:732-636-7813
Mailing Address - Fax:732-636-0830
Practice Address - Street 1:245 AVENEL ST
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1433
Practice Address - Country:US
Practice Address - Phone:732-636-7813
Practice Address - Fax:732-636-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00264600111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT52564Medicare UPIN
NJ099563Medicare ID - Type Unspecified