Provider Demographics
NPI:1871038711
Name:INTRINSIC CHIROPRACTIC OF NEW JERSEY LLC
Entity Type:Organization
Organization Name:INTRINSIC CHIROPRACTIC OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WALKO
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:201-632-1277
Mailing Address - Street 1:227 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1903
Mailing Address - Country:US
Mailing Address - Phone:201-632-1277
Mailing Address - Fax:
Practice Address - Street 1:227 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1903
Practice Address - Country:US
Practice Address - Phone:201-632-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-02
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00740200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty