Provider Demographics
NPI:1457521981
Name:WINSTONE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:WINSTONE CHIROPRACTIC PA
Other - Org Name:NORTHERN VALLEY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-724-2074
Mailing Address - Street 1:500 PIERMONT RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2845
Mailing Address - Country:US
Mailing Address - Phone:201-767-6775
Mailing Address - Fax:201-767-0595
Practice Address - Street 1:500 PIERMONT RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2845
Practice Address - Country:US
Practice Address - Phone:201-767-6775
Practice Address - Fax:201-767-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00572100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081477Medicare PIN