Provider Demographics
NPI:1538304340
Name:SPINAL CARE OF ELIZABETH
Entity Type:Organization
Organization Name:SPINAL CARE OF ELIZABETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-558-9500
Mailing Address - Street 1:230 W JERSEY ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1364
Mailing Address - Country:US
Mailing Address - Phone:908-558-9500
Mailing Address - Fax:908-558-9505
Practice Address - Street 1:230 W JERSEY ST
Practice Address - Street 2:SUITE 306
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1364
Practice Address - Country:US
Practice Address - Phone:908-558-9500
Practice Address - Fax:908-558-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00553500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty