Provider Demographics
NPI:1770940199
Name:MONTCLAIR PERFORMANCE HEALTH AND CHIROPRACTIC INC
Entity type:Organization
Organization Name:MONTCLAIR PERFORMANCE HEALTH AND CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER-PRESID
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GARETH
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-893-5595
Mailing Address - Street 1:546 VALLEY RD, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:973-893-5595
Mailing Address - Fax:973-337-6305
Practice Address - Street 1:546 VALLEY RD., SUITE 103
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:973-893-5595
Practice Address - Fax:973-337-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-16
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00635600111N00000X
111N00000X
NJ38MC00706000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty