Provider Demographics
NPI:1720223969
Name:BEN-EZRA CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:BEN-EZRA CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BEN-EZRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-888-0595
Mailing Address - Street 1:24 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1532
Mailing Address - Country:US
Mailing Address - Phone:732-888-0595
Mailing Address - Fax:732-888-8351
Practice Address - Street 1:24 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1532
Practice Address - Country:US
Practice Address - Phone:732-888-0595
Practice Address - Fax:732-888-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00463200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty