Provider Demographics
NPI:1497936793
Name:MASTERSON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MASTERSON CHIROPRACTIC PC
Other - Org Name:CROSS RIVER MILL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-370-3300
Mailing Address - Street 1:1200 RIVER AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5657
Mailing Address - Country:US
Mailing Address - Phone:732-370-3300
Mailing Address - Fax:732-370-5499
Practice Address - Street 1:1200 RIVER AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5657
Practice Address - Country:US
Practice Address - Phone:732-370-3300
Practice Address - Fax:732-370-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00633000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121865Medicare PIN
NJ5992710001Medicare NSC
NJ086775Medicare PIN
NJV0264Medicare UPIN