Provider Demographics
NPI:1720407844
Name:ANCHORAGE SPINE & PHYSICAL THERAPY CENTER LLC
Entity Type:Organization
Organization Name:ANCHORAGE SPINE & PHYSICAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROBERTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-477-7990
Mailing Address - Street 1:1747 HOOPER AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1747 HOOPER AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8165
Practice Address - Country:US
Practice Address - Phone:732-447-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00671800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty