Provider Demographics
NPI:1629480785
Name:CHIROPRACTIC PAIN MANAGEMENT
Entity Type:Organization
Organization Name:CHIROPRACTIC PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-942-1212
Mailing Address - Street 1:470 CHAMBERLAIN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1031
Mailing Address - Country:US
Mailing Address - Phone:973-942-1212
Mailing Address - Fax:973-942-0523
Practice Address - Street 1:470 CHAMBERLAIN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1031
Practice Address - Country:US
Practice Address - Phone:973-942-1212
Practice Address - Fax:973-942-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00708600305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service