Provider Demographics
NPI:1295125763
Name:PANAIA CHIROPRACTIC & REHABILITATION OF VINELAND
Entity type:Organization
Organization Name:PANAIA CHIROPRACTIC & REHABILITATION OF VINELAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PANAIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-692-5900
Mailing Address - Street 1:242 W LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8109
Mailing Address - Country:US
Mailing Address - Phone:856-692-5900
Mailing Address - Fax:856-692-2848
Practice Address - Street 1:242 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8109
Practice Address - Country:US
Practice Address - Phone:856-692-5900
Practice Address - Fax:856-692-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00496200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty