Provider Demographics
NPI:1528384583
Name:GLEN OAKS HEALTH AND SPINE CENTER LLC
Entity Type:Organization
Organization Name:GLEN OAKS HEALTH AND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:KEMENOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-228-3100
Mailing Address - Street 1:3 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2719
Mailing Address - Country:US
Mailing Address - Phone:856-228-3100
Mailing Address - Fax:856-228-3108
Practice Address - Street 1:3 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2719
Practice Address - Country:US
Practice Address - Phone:856-228-3100
Practice Address - Fax:856-228-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00203400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty