Provider Demographics
NPI:1609032770
Name:PATRICK C MACK DC PC
Entity Type:Organization
Organization Name:PATRICK C MACK DC PC
Other - Org Name:MACK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-689-5110
Mailing Address - Street 1:269 STATE ROUTE 31 S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4086
Mailing Address - Country:US
Mailing Address - Phone:908-689-5110
Mailing Address - Fax:908-689-5409
Practice Address - Street 1:269 STATE ROUTE 31 S
Practice Address - Street 2:SUITE 5
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4086
Practice Address - Country:US
Practice Address - Phone:908-689-5110
Practice Address - Fax:908-689-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00565100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty