Provider Demographics
NPI:1770909509
Name:ADVANCED CHIROPRACTIC REHAB CENTER PC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC REHAB CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:D'ALESSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-228-8600
Mailing Address - Street 1:519 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE L21
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5550
Mailing Address - Country:US
Mailing Address - Phone:973-228-8600
Mailing Address - Fax:
Practice Address - Street 1:519 BLOOMFIELD AVE
Practice Address - Street 2:SUITE L21
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5550
Practice Address - Country:US
Practice Address - Phone:973-228-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00714600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty