Provider Demographics
NPI:1619189719
Name:CALLAHAN FAMILY CHIROPRACTIC AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:CALLAHAN FAMILY CHIROPRACTIC AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-448-1616
Mailing Address - Street 1:93 BAYARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2101
Mailing Address - Country:US
Mailing Address - Phone:732-448-1616
Mailing Address - Fax:732-448-1717
Practice Address - Street 1:93 BAYARD ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2101
Practice Address - Country:US
Practice Address - Phone:732-448-1616
Practice Address - Fax:732-448-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCOO609100111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0035815Medicaid
NJ0035815Medicaid
NJ082758Medicare ID - Type Unspecified