Provider Demographics
NPI:1609011766
Name:BLOZEN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BLOZEN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLOZEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:732-671-7277
Mailing Address - Street 1:2124 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1084
Mailing Address - Country:US
Mailing Address - Phone:732-671-7277
Mailing Address - Fax:732-671-5952
Practice Address - Street 1:2124 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1084
Practice Address - Country:US
Practice Address - Phone:732-671-7277
Practice Address - Fax:732-671-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00308000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1108701Medicaid
NJ446768Medicare PIN