Provider Demographics
NPI:1477799641
Name:COMFORT ZONE CHIROPRACTIC & REHABILITATION, LLC
Entity type:Organization
Organization Name:COMFORT ZONE CHIROPRACTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-234-1200
Mailing Address - Street 1:3829 CHURCH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1105
Mailing Address - Country:US
Mailing Address - Phone:856-234-1200
Mailing Address - Fax:856-787-1901
Practice Address - Street 1:3829 CHURCH RD
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1105
Practice Address - Country:US
Practice Address - Phone:856-234-1200
Practice Address - Fax:856-787-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071005Medicare PIN
NJU84066Medicare UPIN