Provider Demographics
NPI:1972661676
Name:OCEAN GROVE FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:OCEAN GROVE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-774-1933
Mailing Address - Street 1:77 MAIN AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1389
Mailing Address - Country:US
Mailing Address - Phone:732-774-1933
Mailing Address - Fax:732-774-2463
Practice Address - Street 1:77 MAIN AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-1389
Practice Address - Country:US
Practice Address - Phone:732-774-1933
Practice Address - Fax:732-774-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00555000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ108303Medicare PIN