Provider Demographics
NPI:1669612628
Name:SOUTH ORANGE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:SOUTH ORANGE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-761-0022
Mailing Address - Street 1:60 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1916
Mailing Address - Country:US
Mailing Address - Phone:973-761-0022
Mailing Address - Fax:973-761-1546
Practice Address - Street 1:60 1ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1916
Practice Address - Country:US
Practice Address - Phone:973-761-0022
Practice Address - Fax:973-761-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 03031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
149347Medicare UPIN