Provider Demographics
NPI:1831437748
Name:ANDO CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ANDO CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEIICHIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:201-496-6066
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:STE 101
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:201-496-6066
Mailing Address - Fax:201-496-6067
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:STE 101
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-496-6066
Practice Address - Fax:201-496-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00673300111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty