Provider Demographics
NPI:1659531507
Name:BRIAN M. WRAITH, DOCTOR OF CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:BRIAN M. WRAITH, DOCTOR OF CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-945-2032
Mailing Address - Street 1:323 BERGEN BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1334
Mailing Address - Country:US
Mailing Address - Phone:201-945-2032
Mailing Address - Fax:
Practice Address - Street 1:323 BERGEN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1334
Practice Address - Country:US
Practice Address - Phone:201-945-2032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00622800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095364Medicare UPIN