Provider Demographics
NPI:1851453138
Name:JOHN D. KRISCIUNAS JR. D.C., P.C.
Entity Type:Organization
Organization Name:JOHN D. KRISCIUNAS JR. D.C., P.C.
Other - Org Name:PERFORMANCE CHIROPRACTIC AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KRISCIUNAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:856-401-9550
Mailing Address - Street 1:860 ROUTE 168
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3215
Mailing Address - Country:US
Mailing Address - Phone:856-401-9550
Mailing Address - Fax:856-401-9551
Practice Address - Street 1:860 ROUTE 168
Practice Address - Street 2:SUITE 104
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3215
Practice Address - Country:US
Practice Address - Phone:856-401-9550
Practice Address - Fax:856-401-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00486700111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5002456OtherAETNA PROVIDER ID
PA000150906OtherPA BCBS PROVIDER ID
NJ0172698000OtherAMERIHEALTH HMO ID
NJ0939277OtherAETNA PROVIDER ID
NJ0172698000OtherKEYSTONE PROVIDER ID
NJ0172698000OtherKEYSTONE PROVIDER ID
NJ=========0OtherCIGNA PROVIDER ID
PA893362Medicare PIN