Provider Demographics
NPI:1497967525
Name:MAIN CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:MAIN CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LAKERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-482-1626
Mailing Address - Street 1:201 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052
Mailing Address - Country:US
Mailing Address - Phone:856-482-1626
Mailing Address - Fax:856-482-8481
Practice Address - Street 1:201 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052
Practice Address - Country:US
Practice Address - Phone:856-482-1626
Practice Address - Fax:856-482-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00539600111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty