Provider Demographics
NPI:1881227528
Name:PRIME SPINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PRIME SPINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGRETI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-598-9905
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:TENNENT
Mailing Address - State:NJ
Mailing Address - Zip Code:07763-0285
Mailing Address - Country:US
Mailing Address - Phone:732-598-9905
Mailing Address - Fax:
Practice Address - Street 1:202 MOUNTS CORNER DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2547
Practice Address - Country:US
Practice Address - Phone:732-908-2128
Practice Address - Fax:732-652-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty