Provider Demographics
NPI:1780031708
Name:SHORELINE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SHORELINE CHIROPRACTIC LLC
Other - Org Name:CARSKADDAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-255-8335
Mailing Address - Street 1:1901 HOOPER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-1600
Mailing Address - Country:US
Mailing Address - Phone:732-255-8335
Mailing Address - Fax:732-255-8261
Practice Address - Street 1:1901 HOOPER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-1600
Practice Address - Country:US
Practice Address - Phone:732-255-8335
Practice Address - Fax:732-255-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00607400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU499528Medicare UPIN