Provider Demographics
NPI:1962677948
Name:MOTION CHIROPRACTIC CENTER OF RARITAN, LLC
Entity Type:Organization
Organization Name:MOTION CHIROPRACTIC CENTER OF RARITAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTICERMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-541-1234
Mailing Address - Street 1:44 E SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2114
Mailing Address - Country:US
Mailing Address - Phone:908-541-1234
Mailing Address - Fax:908-541-1210
Practice Address - Street 1:44 E SOMERSET ST
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-2114
Practice Address - Country:US
Practice Address - Phone:908-541-1234
Practice Address - Fax:908-541-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00541300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031612Medicare PIN