Provider Demographics
NPI:1750462263
Name:DR. MIKE'S CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DR. MIKE'S CHIROPRACTIC LLC
Other - Org Name:DISCOVER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GRODZIELANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-401-0102
Mailing Address - Street 1:69 S. BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-401-0102
Mailing Address - Fax:856-374-2345
Practice Address - Street 1:69 S. BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-401-0102
Practice Address - Fax:856-374-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00587200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty