Provider Demographics
NPI:1750579405
Name:ADVANCED CHIROPRACTIC HEALTHCARE, LLC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAREMBOYM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-340-1006
Mailing Address - Street 1:57 BRANT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1568
Mailing Address - Country:US
Mailing Address - Phone:732-340-1006
Mailing Address - Fax:732-340-1433
Practice Address - Street 1:57 BRANT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1568
Practice Address - Country:US
Practice Address - Phone:732-340-1006
Practice Address - Fax:732-340-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00568300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8320101Medicaid
U81427Medicare UPIN
NJ8320101Medicaid
NJ6074060001Medicare NSC