Provider Demographics
NPI:1790870343
Name:GIANCOLA CHIROPRACTIC
Entity Type:Organization
Organization Name:GIANCOLA CHIROPRACTIC
Other - Org Name:GINA M GIANCOLA, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIANCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-237-1221
Mailing Address - Street 1:1425 POMPTON AVENUE
Mailing Address - Street 2:SUITE 2-1A
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009
Mailing Address - Country:US
Mailing Address - Phone:973-237-1221
Mailing Address - Fax:973-237-1991
Practice Address - Street 1:1425 POMPTON AVENUE
Practice Address - Street 2:SUITE 2-1A
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009
Practice Address - Country:US
Practice Address - Phone:973-237-1221
Practice Address - Fax:973-237-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00517900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU80206Medicare UPIN
NJ037744Medicare ID - Type Unspecified