Provider Demographics
NPI:1821227927
Name:BURLINGTON COUNTY SPINE & REHABILITATION LLC
Entity Type:Organization
Organization Name:BURLINGTON COUNTY SPINE & REHABILITATION LLC
Other - Org Name:GLOUCESTER COUNTY SPINE & REHABILITATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-235-0202
Mailing Address - Street 1:103 MASONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1612
Mailing Address - Country:US
Mailing Address - Phone:856-235-0202
Mailing Address - Fax:856-235-3377
Practice Address - Street 1:501 ROUTE 168
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1458
Practice Address - Country:US
Practice Address - Phone:856-685-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty