Provider Demographics
NPI:1609315548
Name:MCCUE CHIROPRACTIC CENTERS LLC
Entity Type:Organization
Organization Name:MCCUE CHIROPRACTIC CENTERS LLC
Other - Org Name:RIVERS EDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:609-397-4390
Mailing Address - Street 1:45 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-1734
Mailing Address - Country:US
Mailing Address - Phone:609-397-4390
Mailing Address - Fax:
Practice Address - Street 1:45 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-1734
Practice Address - Country:US
Practice Address - Phone:609-397-4390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00620500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty