Provider Demographics
NPI:1184784449
Name:SANTANGELO CHIROPRACTIC AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:SANTANGELO CHIROPRACTIC AND REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-428-8244
Mailing Address - Street 1:1 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3203
Mailing Address - Country:US
Mailing Address - Phone:973-428-8244
Mailing Address - Fax:973-428-8123
Practice Address - Street 1:1 HEATHER DR
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3203
Practice Address - Country:US
Practice Address - Phone:973-428-8244
Practice Address - Fax:973-428-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00181400111N00000X, 111NS0005X, 111NR0400X
171100000X, 225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070129Medicare UPIN