Provider Demographics
NPI:1942237995
Name:LAFAYETTE STREET CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:LAFAYETTE STREET CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURRINI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:973-466-3810
Mailing Address - Street 1:123 CLIFFORD STREET, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:973-466-3810
Mailing Address - Fax:
Practice Address - Street 1:123 CLIFFORD ST., STE 105
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-466-3810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00539100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty