Provider Demographics
NPI:1487685962
Name:SPINAZZOLA, VINCENT G (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:G
Last Name:SPINAZZOLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3215
Mailing Address - Country:US
Mailing Address - Phone:201-460-9010
Mailing Address - Fax:201-460-7422
Practice Address - Street 1:747 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3215
Practice Address - Country:US
Practice Address - Phone:201-460-9010
Practice Address - Fax:201-460-7422
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00394400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083587S3JMedicare PIN