Provider Demographics
NPI:1336355205
Name:EATONTOWN ELITE CARE CENTER, LLC
Entity Type:Organization
Organization Name:EATONTOWN ELITE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-389-2800
Mailing Address - Street 1:40 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3405
Mailing Address - Country:US
Mailing Address - Phone:732-389-2800
Mailing Address - Fax:732-389-0246
Practice Address - Street 1:40 SOUTH ST
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3405
Practice Address - Country:US
Practice Address - Phone:732-389-2800
Practice Address - Fax:732-389-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00593000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty