Provider Demographics
NPI:1508262593
Name:KIRKWOOD PAIN & INJURY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:KIRKWOOD PAIN & INJURY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-803-3818
Mailing Address - Street 1:600 NE FRONT STREET EXT
Mailing Address - Street 2:SUITE D
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 NE FRONT STREET EXT
Practice Address - Street 2:SUITE D
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1395
Practice Address - Country:US
Practice Address - Phone:302-422-2329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000881111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty