Provider Demographics
NPI:1265057699
Name:EDISON SPINE & JOINT CARE LLC
Entity type:Organization
Organization Name:EDISON SPINE & JOINT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EAGELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-881-6171
Mailing Address - Street 1:2 LINCOLN HIGHWAY
Mailing Address - Street 2:SUITE 311A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-243-9252
Mailing Address - Fax:732-243-9253
Practice Address - Street 1:2 LINCOLN HIGHWAY
Practice Address - Street 2:SUITE 311A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-243-9252
Practice Address - Fax:732-243-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty