Provider Demographics
NPI:1770600520
Name:MULLICA HILL CHIROPRACTIC
Entity type:Organization
Organization Name:MULLICA HILL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-223-5876
Mailing Address - Street 1:47 WOODSTOWN RD
Mailing Address - Street 2:PO BOX 412
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062
Mailing Address - Country:US
Mailing Address - Phone:856-223-5876
Mailing Address - Fax:856-223-8615
Practice Address - Street 1:47 WOODSTOWN RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062
Practice Address - Country:US
Practice Address - Phone:856-223-5876
Practice Address - Fax:856-223-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00569800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066789Medicare ID - Type Unspecified