Provider Demographics
NPI:1215756382
Name:SPINE CARE CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:SPINE CARE CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FESSIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-405-3872
Mailing Address - Street 1:520 MAIN STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:973-405-3872
Mailing Address - Fax:
Practice Address - Street 1:520 MAIN STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:862-344-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty