Provider Demographics
NPI:1336783760
Name:440 CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:440 CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:646-831-1300
Mailing Address - Street 1:701 STATE RT 440 STE 33
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1069
Mailing Address - Country:US
Mailing Address - Phone:201-435-4558
Mailing Address - Fax:201-435-4588
Practice Address - Street 1:701 STATE RT 440 STE 33
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1069
Practice Address - Country:US
Practice Address - Phone:201-435-4558
Practice Address - Fax:201-435-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty