Provider Demographics
NPI:1932692811
Name:SUMMIT CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLIRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-778-2773
Mailing Address - Street 1:9 BROADWAY # SS
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1937
Mailing Address - Country:US
Mailing Address - Phone:609-778-2773
Mailing Address - Fax:609-778-2774
Practice Address - Street 1:9 BROADWAY UNIT A
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:770-685-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00748100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty