Provider Demographics
NPI:1962689984
Name:BACK PAIN CLINIC OF COLLINGSWOOD,INC.,P.A.
Entity Type:Organization
Organization Name:BACK PAIN CLINIC OF COLLINGSWOOD,INC.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHIPSKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:856-857-9595
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-5262
Mailing Address - Country:US
Mailing Address - Phone:856-957-9595
Mailing Address - Fax:
Practice Address - Street 1:501 N HADDON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1753
Practice Address - Country:US
Practice Address - Phone:856-857-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00332500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5667526 PINOtherAETNA
NJP2939905OtherOXFORD
NJ0949448 GRPOtherAETNA
NJ5974547 PINOtherAETNA
NJ0110676 GRPOtherAMERIHEALTH
NJ2360862 GRPOtherAETNA
NJU68802Medicare UPIN
NJ2360862 GRPOtherAETNA