Provider Demographics
NPI:1861683831
Name:VILLANI CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:VILLANI CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUERRIERO-VILLANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-857-1119
Mailing Address - Street 1:80 POMPTON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2945
Mailing Address - Country:US
Mailing Address - Phone:973-857-1119
Mailing Address - Fax:973-857-7480
Practice Address - Street 1:80 POMPTON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2945
Practice Address - Country:US
Practice Address - Phone:973-857-1119
Practice Address - Fax:973-857-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ045711Medicare UPIN