Provider Demographics
NPI:1770689176
Name:PASSAIC CHIROPRACTIC & THERAPY CENTER PC
Entity Type:Organization
Organization Name:PASSAIC CHIROPRACTIC & THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-777-5400
Mailing Address - Street 1:647 MAIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4934
Mailing Address - Country:US
Mailing Address - Phone:973-777-5400
Mailing Address - Fax:973-777-5445
Practice Address - Street 1:647 MAIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4934
Practice Address - Country:US
Practice Address - Phone:973-777-5400
Practice Address - Fax:973-777-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00301100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ451089SLFMedicare ID - Type Unspecified
NJT45177Medicare UPIN