Provider Demographics
NPI:1730309071
Name:ERIC CHLUDZINSKI, PC
Entity Type:Organization
Organization Name:ERIC CHLUDZINSKI, PC
Other - Org Name:FANWOOD BACK RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CHLUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-288-7129
Mailing Address - Street 1:193 TERRILL RD
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1018
Mailing Address - Country:US
Mailing Address - Phone:908-288-7129
Mailing Address - Fax:
Practice Address - Street 1:193 TERRILL RD
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1018
Practice Address - Country:US
Practice Address - Phone:908-288-7129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC06002111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ=========OtherTAX ID
NJU96057Medicare UPIN