Provider Demographics
NPI:1821300229
Name:CREEDON CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CREEDON CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CREEDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-795-5333
Mailing Address - Street 1:200 BRACE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2623
Mailing Address - Country:US
Mailing Address - Phone:856-795-5333
Mailing Address - Fax:856-795-5336
Practice Address - Street 1:200 BRACE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2623
Practice Address - Country:US
Practice Address - Phone:856-795-5333
Practice Address - Fax:856-795-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00212700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty