Provider Demographics
NPI:1679099832
Name:MONTCLAIR UPPER CERVICAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MONTCLAIR UPPER CERVICAL CHIROPRACTIC LLC
Other - Org Name:UPPER CERVICAL HEALTH CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PECCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-744-3456
Mailing Address - Street 1:155 PROSPECT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4204
Mailing Address - Country:US
Mailing Address - Phone:973-744-3456
Mailing Address - Fax:
Practice Address - Street 1:155 PROSPECT AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4204
Practice Address - Country:US
Practice Address - Phone:862-520-1329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00742200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty