Provider Demographics
NPI:1790717577
Name:SUBLUX PC
Entity Type:Organization
Organization Name:SUBLUX PC
Other - Org Name:ATLANTIC CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-487-0800
Mailing Address - Street 1:3 N BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2002
Mailing Address - Country:US
Mailing Address - Phone:609-487-0800
Mailing Address - Fax:609-822-8785
Practice Address - Street 1:3 N BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2002
Practice Address - Country:US
Practice Address - Phone:609-487-0800
Practice Address - Fax:609-822-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00637800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093925Medicare ID - Type Unspecified