Provider Demographics
NPI:1700344835
Name:DYNAMIC CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SCARPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-680-1909
Mailing Address - Street 1:720 E MAIN ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3058
Mailing Address - Country:US
Mailing Address - Phone:517-214-7705
Mailing Address - Fax:
Practice Address - Street 1:720 E MAIN ST STE 1D
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3058
Practice Address - Country:US
Practice Address - Phone:517-214-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty