Provider Demographics
NPI:1972692747
Name:BRUCE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:BRUCE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZUIDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-547-6587
Mailing Address - Street 1:708 STATION AVENUE
Mailing Address - Street 2:BRUCE CHIROPRACTIC CENTER LLC
Mailing Address - City:HADDON HTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1647
Mailing Address - Country:US
Mailing Address - Phone:856-547-6587
Mailing Address - Fax:856-547-6995
Practice Address - Street 1:708 STATION AVENUE
Practice Address - Street 2:
Practice Address - City:HADDON HTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1647
Practice Address - Country:US
Practice Address - Phone:856-547-6587
Practice Address - Fax:856-547-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00648600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
063958Medicare ID - Type Unspecified