Provider Demographics
NPI:1639365778
Name:HENNESSY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:HENNESSY CHIROPRACTIC CENTER LLC
Other - Org Name:HENNESSY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-264-2223
Mailing Address - Street 1:224 MIDDLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1900
Mailing Address - Country:US
Mailing Address - Phone:732-264-2223
Mailing Address - Fax:732-264-2223
Practice Address - Street 1:224 MIDDLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1900
Practice Address - Country:US
Practice Address - Phone:732-264-2223
Practice Address - Fax:732-264-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty