Provider Demographics
NPI:1871634121
Name:JERSEY SHORE CHIROPRACTIC CENTER,LLC
Entity Type:Organization
Organization Name:JERSEY SHORE CHIROPRACTIC CENTER,LLC
Other - Org Name:KENNETH ZAMMITO, DC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZAMMITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-693-2020
Mailing Address - Street 1:442 W. LACEY RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-2436
Mailing Address - Country:US
Mailing Address - Phone:609-693-2020
Mailing Address - Fax:609-693-8330
Practice Address - Street 1:442 W. LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2436
Practice Address - Country:US
Practice Address - Phone:609-693-2020
Practice Address - Fax:609-693-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
121652Medicare PIN