Provider Demographics
NPI:1730322587
Name:FAIR LAWN CHIROPRACTIC THERAPY LLC
Entity Type:Organization
Organization Name:FAIR LAWN CHIROPRACTIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALAF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-595-6444
Mailing Address - Street 1:14-25 PLAZA RD
Mailing Address - Street 2:SUITE S24
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3546
Mailing Address - Country:US
Mailing Address - Phone:973-797-7373
Mailing Address - Fax:973-782-4819
Practice Address - Street 1:14-25 PLAZA RD
Practice Address - Street 2:SUITE S24
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3546
Practice Address - Country:US
Practice Address - Phone:973-797-7373
Practice Address - Fax:973-782-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty