Provider Demographics
NPI:1942672936
Name:MONMOUTH SPORTS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:MONMOUTH SPORTS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-617-8000
Mailing Address - Street 1:436 ROUTE 79
Mailing Address - Street 2:SUITE 21
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751
Mailing Address - Country:US
Mailing Address - Phone:732-617-8000
Mailing Address - Fax:
Practice Address - Street 1:436 ROUTE 79
Practice Address - Street 2:SUITE 21
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:732-617-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00707000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty