Provider Demographics
NPI:1558539825
Name:ADVANCED CHIROPRACTIC CENTER OF WOODBRIDGE, INC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CENTER OF WOODBRIDGE, INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUISEPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-634-5155
Mailing Address - Street 1:415 AVENEL ST STE B
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1281
Mailing Address - Country:US
Mailing Address - Phone:732-634-5155
Mailing Address - Fax:732-634-7850
Practice Address - Street 1:415 AVENEL ST STE B
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1281
Practice Address - Country:US
Practice Address - Phone:732-634-5155
Practice Address - Fax:732-634-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00631200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092128Medicare PIN