Provider Demographics
NPI:1871850354
Name:BLOOMINGDALE CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:BLOOMINGDALE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:973-492-1568
Mailing Address - Street 1:235 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1924
Mailing Address - Country:US
Mailing Address - Phone:973-492-1568
Mailing Address - Fax:973-492-0279
Practice Address - Street 1:235 UNION AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1924
Practice Address - Country:US
Practice Address - Phone:973-492-1568
Practice Address - Fax:973-492-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00203800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790756120OtherNPI
1790756120OtherNPI