Provider Demographics
NPI:1841755360
Name:ERMANN CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ERMANN CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-836-1900
Mailing Address - Street 1:315 CEDAR LN STE 1
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3442
Mailing Address - Country:US
Mailing Address - Phone:201-836-1900
Mailing Address - Fax:201-836-4502
Practice Address - Street 1:315 CEDAR LN STE 1
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3442
Practice Address - Country:US
Practice Address - Phone:201-836-1900
Practice Address - Fax:201-836-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1306978564Medicaid
NJ1548660582Medicaid
NJ1699094045Medicaid
NJ1013428978Medicaid
NY1871617613Medicaid
NJ1306159462Medicaid
NJ1336674613Medicaid