Provider Demographics
NPI:1598221319
Name:NJ GONSTEAD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NJ GONSTEAD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEONGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-269-5491
Mailing Address - Street 1:666 PLAINSBORO RD STE 1230
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3046
Mailing Address - Country:US
Mailing Address - Phone:609-269-5491
Mailing Address - Fax:
Practice Address - Street 1:666 PLAINSBORO RD STE 1230
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3046
Practice Address - Country:US
Practice Address - Phone:609-269-5491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty