Provider Demographics
NPI:1750509402
Name:BERGEN SPINE CENTER, LLC
Entity Type:Organization
Organization Name:BERGEN SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-945-9993
Mailing Address - Street 1:323 BERGEN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1334
Mailing Address - Country:US
Mailing Address - Phone:201-945-9993
Mailing Address - Fax:201-945-8873
Practice Address - Street 1:323 BERGEN BOULEVARD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1334
Practice Address - Country:US
Practice Address - Phone:201-945-9993
Practice Address - Fax:201-945-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00653900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty