Provider Demographics
NPI:1891043394
Name:RICHARD MACZUGA CHIROPRACTOR LLC
Entity Type:Organization
Organization Name:RICHARD MACZUGA CHIROPRACTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MACZUGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-823-0303
Mailing Address - Street 1:1160 KENNEDY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3128
Mailing Address - Country:US
Mailing Address - Phone:201-823-0303
Mailing Address - Fax:201-436-6180
Practice Address - Street 1:1160 KENNEDY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3128
Practice Address - Country:US
Practice Address - Phone:201-823-0303
Practice Address - Fax:201-436-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty