Provider Demographics
NPI:1477874022
Name:UPPER CERVICAL CHIROPRACTIC OF MONMOUTH, LLC
Entity Type:Organization
Organization Name:UPPER CERVICAL CHIROPRACTIC OF MONMOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S,
Authorized Official - Last Name:ARBEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-617-9355
Mailing Address - Street 1:25 KILMER DR
Mailing Address - Street 2:BLDG 3-SUITE 101
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1564
Mailing Address - Country:US
Mailing Address - Phone:732-617-9355
Mailing Address - Fax:732-617-9334
Practice Address - Street 1:25 KILMER DR
Practice Address - Street 2:BLDG 3-SUITE 101
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1564
Practice Address - Country:US
Practice Address - Phone:732-617-9355
Practice Address - Fax:732-617-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00618100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1558451831OtherINDIVIDUAL NPI
NJV03406Medicare UPIN
NJ089221Medicare PIN