Provider Demographics
NPI:1790731149
Name:KATIMARK COMPANY, INC
Entity Type:Organization
Organization Name:KATIMARK COMPANY, INC
Other - Org Name:LOLLA CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:LOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-748-8800
Mailing Address - Street 1:161 W WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9447
Mailing Address - Country:US
Mailing Address - Phone:699-748-8800
Mailing Address - Fax:609-748-2855
Practice Address - Street 1:161 W WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9447
Practice Address - Country:US
Practice Address - Phone:699-748-8800
Practice Address - Fax:609-748-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00330200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty