Provider Demographics
NPI:1760886329
Name:STRUCTURAL CHIROPRACTIC
Entity Type:Organization
Organization Name:STRUCTURAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DAMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-452-4764
Mailing Address - Street 1:317 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1822
Mailing Address - Country:US
Mailing Address - Phone:201-588-3840
Mailing Address - Fax:
Practice Address - Street 1:317 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1822
Practice Address - Country:US
Practice Address - Phone:201-588-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00448300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty