Provider Demographics
NPI:1750821112
Name:BIRD CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BIRD CHIROPRACTIC, LLC
Other - Org Name:BIRD CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-783-6789
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:BUILDING B SUITE 200
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4406
Mailing Address - Country:US
Mailing Address - Phone:856-783-6789
Mailing Address - Fax:856-783-7199
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:BUILDING B SUITE 200
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4406
Practice Address - Country:US
Practice Address - Phone:856-783-6789
Practice Address - Fax:856-783-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00606300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1376690750OtherINDIVIDUAL NPI
NJ1376690750OtherINDIVIDUAL NPI
NJ066247Medicare PIN