Provider Demographics
NPI:1558806349
Name:I CONNECT FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:I CONNECT FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MINUSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:570-362-8156
Mailing Address - Street 1:46 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2125
Mailing Address - Country:US
Mailing Address - Phone:570-362-8156
Mailing Address - Fax:
Practice Address - Street 1:46 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2125
Practice Address - Country:US
Practice Address - Phone:570-362-8156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00740300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty