Provider Demographics
NPI:1740305648
Name:IMBROGNO CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:IMBROGNO CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IMBROGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-783-0444
Mailing Address - Street 1:33 PLYMOUTH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2677
Mailing Address - Country:US
Mailing Address - Phone:973-783-0444
Mailing Address - Fax:973-783-4428
Practice Address - Street 1:33 PLYMOUTH ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:973-783-0444
Practice Address - Fax:973-783-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00415400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ449615Medicare ID - Type UnspecifiedMEDICARE NUMBER
NJ=========OtherTAX ID