Provider Demographics
NPI:1497084537
Name:KNICKERBOCKER CHIROPRACTIC CENTRE
Entity Type:Organization
Organization Name:KNICKERBOCKER CHIROPRACTIC CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-768-6605
Mailing Address - Street 1:27 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1904
Mailing Address - Country:US
Mailing Address - Phone:201-768-6605
Mailing Address - Fax:201-768-0667
Practice Address - Street 1:27 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-1904
Practice Address - Country:US
Practice Address - Phone:201-768-6605
Practice Address - Fax:201-768-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00242800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty