Provider Demographics
NPI:1255427423
Name:COLONIAL VALLEY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:COLONIAL VALLEY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:609-912-0062
Mailing Address - Street 1:136 LAWRENCEVILLE PENNING RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1413
Mailing Address - Country:US
Mailing Address - Phone:609-912-0062
Mailing Address - Fax:609-912-0064
Practice Address - Street 1:136 LAWRENCEVILLE PENNING RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1413
Practice Address - Country:US
Practice Address - Phone:609-912-0062
Practice Address - Fax:609-912-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty