Provider Demographics
NPI:1851661698
Name:CHIROPRACTIC CARE OF BEDMINSTER, P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE OF BEDMINSTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAVROSTOMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CKTP
Authorized Official - Phone:909-234-2317
Mailing Address - Street 1:1 ROBERTSON DRIVE
Mailing Address - Street 2:STE 21
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921
Mailing Address - Country:US
Mailing Address - Phone:908-234-2317
Mailing Address - Fax:908-234-0975
Practice Address - Street 1:1 ROBERTSON DRIVE
Practice Address - Street 2:STE 21
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921
Practice Address - Country:US
Practice Address - Phone:908-234-2317
Practice Address - Fax:908-234-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00525500332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU72617Medicare UPIN