Provider Demographics
NPI:1811078918
Name:WHIPPANY CHIROPRACTIC LIFE CENTER, P.C.
Entity type:Organization
Organization Name:WHIPPANY CHIROPRACTIC LIFE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BRZOZOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-884-1500
Mailing Address - Street 1:831 STATE ROUTE 10
Mailing Address - Street 2:STR. 16
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1154
Mailing Address - Country:US
Mailing Address - Phone:973-884-1500
Mailing Address - Fax:973-884-9656
Practice Address - Street 1:831 STATE ROUTE 10
Practice Address - Street 2:STR. 16
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1154
Practice Address - Country:US
Practice Address - Phone:973-884-1500
Practice Address - Fax:973-884-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00521800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP1935342OtherOXFORD
NJP1935342OtherOXFORD
NJU72621Medicare UPIN