Provider Demographics
NPI:1669554473
Name:ROCKAWAY FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ROCKAWAY FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-998-5909
Mailing Address - Street 1:35 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3566
Mailing Address - Country:US
Mailing Address - Phone:973-998-5909
Mailing Address - Fax:973-998-5908
Practice Address - Street 1:35 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3566
Practice Address - Country:US
Practice Address - Phone:973-998-5909
Practice Address - Fax:973-998-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ906717Medicare ID - Type Unspecified