Provider Demographics
NPI:1952331290
Name:FOXMOOR CHIROPRACTIC CENTER L.L.C.
Entity Type:Organization
Organization Name:FOXMOOR CHIROPRACTIC CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GELLASCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-631-8969
Mailing Address - Street 1:2791 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1854
Mailing Address - Country:US
Mailing Address - Phone:609-631-8969
Mailing Address - Fax:609-631-0052
Practice Address - Street 1:2791 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1854
Practice Address - Country:US
Practice Address - Phone:609-631-8969
Practice Address - Fax:609-631-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC-04948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0091180000OtherAMERIHEALTH HMO/KEYSTONE