Provider Demographics
NPI:1467701920
Name:EAST COAST CHIROPRACTIC AND REHAB CENTER
Entity Type:Organization
Organization Name:EAST COAST CHIROPRACTIC AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COZART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-404-7797
Mailing Address - Street 1:126 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5266
Mailing Address - Country:US
Mailing Address - Phone:609-404-7797
Mailing Address - Fax:609-404-7790
Practice Address - Street 1:314 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4464
Practice Address - Country:US
Practice Address - Phone:609-404-7797
Practice Address - Fax:609-404-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00688400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty