Provider Demographics
NPI:1619948932
Name:CIANCIULLI CHIROPRACTIC GROUP, LLC
Entity Type:Organization
Organization Name:CIANCIULLI CHIROPRACTIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIANCIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-289-6515
Mailing Address - Street 1:422 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1553
Mailing Address - Country:US
Mailing Address - Phone:908-289-6515
Mailing Address - Fax:908-289-3631
Practice Address - Street 1:422 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1553
Practice Address - Country:US
Practice Address - Phone:908-289-6515
Practice Address - Fax:908-289-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050215Medicare PIN