Provider Demographics
NPI:1598814188
Name:HENDLEY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:HENDLEY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:HENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-788-3539
Mailing Address - Street 1:30 S MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7922
Mailing Address - Country:US
Mailing Address - Phone:609-839-9408
Mailing Address - Fax:
Practice Address - Street 1:52 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2380
Practice Address - Country:US
Practice Address - Phone:609-788-3539
Practice Address - Fax:609-788-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00639900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0102296Medicaid
NJ12438166OtherMULTIPLAN
NJ7290801OtherAETNA
NJ1003914623OtherNPI PERSONAL ID NUMBER
NJ2724756000OtherAMERIHEALTH
NJ7290801OtherAETNA