Provider Demographics
NPI:1629618020
Name:MUNDIE CHIROPRACTIC
Entity Type:Organization
Organization Name:MUNDIE CHIROPRACTIC
Other - Org Name:SHORE SPINE AND SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-503-8332
Mailing Address - Street 1:312 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741-1045
Mailing Address - Country:US
Mailing Address - Phone:732-503-8332
Mailing Address - Fax:
Practice Address - Street 1:2 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7172
Practice Address - Country:US
Practice Address - Phone:732-503-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669915435OtherNPI
NJ38MC00739700OtherCHIROPRACTIC LICENSE NUMBER