Provider Demographics
NPI:1760705552
Name:SM CHIROPRACTIC & PAIN CLINIC P.C.
Entity Type:Organization
Organization Name:SM CHIROPRACTIC & PAIN CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:SAMUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-207-0023
Mailing Address - Street 1:460 BERGEN BLVD
Mailing Address - Street 2:SUIT 304
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2300
Mailing Address - Country:US
Mailing Address - Phone:201-207-0023
Mailing Address - Fax:
Practice Address - Street 1:1711 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3471
Practice Address - Country:US
Practice Address - Phone:201-207-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty