Provider Demographics
NPI:1760906531
Name:TWIN MEADOWS LLC
Entity Type:Organization
Organization Name:TWIN MEADOWS LLC
Other - Org Name:PRECISION SPINE AND SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPORTS CHIROPRACTOR / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:DIJKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-525-7213
Mailing Address - Street 1:10 COREY LN
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-3309
Mailing Address - Country:US
Mailing Address - Phone:973-525-7213
Mailing Address - Fax:
Practice Address - Street 1:384 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1659
Practice Address - Country:US
Practice Address - Phone:973-525-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00735600111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty