Provider Demographics
NPI:1902835085
Name:BIDWELL CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:BIDWELL CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-273-1551
Mailing Address - Street 1:212 WEST ROUTE 38
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057
Mailing Address - Country:US
Mailing Address - Phone:856-273-1551
Mailing Address - Fax:856-273-9988
Practice Address - Street 1:212 WEST ROUTE 38
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-273-1551
Practice Address - Fax:856-273-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7755104Medicaid
U70578Medicare UPIN
NJ009798Medicare ID - Type Unspecified