Provider Demographics
NPI:1891816914
Name:ADVANCED SPINE CARE AND PHYSICAL REHABILITATION,LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE CARE AND PHYSICAL REHABILITATION,LLC
Other - Org Name:LAMBROU CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMBROS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAMBROU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-415-1401
Mailing Address - Street 1:728 BENNETTS MILLS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3850
Mailing Address - Country:US
Mailing Address - Phone:732-415-1401
Mailing Address - Fax:732-415-1403
Practice Address - Street 1:728 BENNETTS MILLS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3850
Practice Address - Country:US
Practice Address - Phone:732-415-1401
Practice Address - Fax:732-415-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05652261QM1300X
NJ7427430001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080009Medicare ID - Type UnspecifiedCHIROPRACTIC GROUP
NJ7427430001Medicare NSC