Provider Demographics
NPI:1578860730
Name:EMERY CHIROPRACTIC GROUP, LLC
Entity Type:Organization
Organization Name:EMERY CHIROPRACTIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-447-3707
Mailing Address - Street 1:310 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2609
Mailing Address - Country:US
Mailing Address - Phone:201-447-3707
Mailing Address - Fax:201-447-0320
Practice Address - Street 1:310 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2609
Practice Address - Country:US
Practice Address - Phone:201-447-3707
Practice Address - Fax:201-447-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00312100111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P643830OtherOXFORD
0076805OtherAETNA
P00022961OtherRAIL ROAD MEDICARE
607510OtherUNITED HEALTHCARE
NJT45333Medicare UPIN
NJ148505160Medicare PIN