Provider Demographics
NPI:1598162968
Name:PEAK CHIROPRACTIC & WELLNESS LLC
Entity Type:Organization
Organization Name:PEAK CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:862-576-1263
Mailing Address - Street 1:411 419 CHESTNUT ST
Mailing Address - Street 2:1A
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:862-237-7801
Mailing Address - Fax:862-237-7803
Practice Address - Street 1:411 419 CHESTNUT ST
Practice Address - Street 2:1A
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:862-237-7801
Practice Address - Fax:862-237-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00697700111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty