Provider Demographics
NPI:1659588796
Name:VILLAGE FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:VILLAGE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FEDICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-813-8200
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:VILLAGE SQUARE AT PANTHER VALLEY
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07820-0333
Mailing Address - Country:US
Mailing Address - Phone:908-813-8200
Mailing Address - Fax:
Practice Address - Street 1:773 ROUTE 517
Practice Address - Street 2:VILLAGE SQUARE AT PANTHER VALLEY
Practice Address - City:ALLAMUCHY
Practice Address - State:NJ
Practice Address - Zip Code:07820-0333
Practice Address - Country:US
Practice Address - Phone:908-813-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00621900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ079247Medicare ID - Type Unspecified