Provider Demographics
NPI:1992857858
Name:BERGEN CHIROPRACTIC AND SPORTS REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:BERGEN CHIROPRACTIC AND SPORTS REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:201-945-4075
Mailing Address - Street 1:532 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1721
Mailing Address - Country:US
Mailing Address - Phone:201-945-4075
Mailing Address - Fax:201-945-4070
Practice Address - Street 1:532 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1721
Practice Address - Country:US
Practice Address - Phone:201-945-4075
Practice Address - Fax:201-945-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5189111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5899548OtherGHI
NJ5899548OtherGHI