Provider Demographics
NPI:1881722460
Name:MOTION CHIROPRACTIC GROUP PC
Entity type:Organization
Organization Name:MOTION CHIROPRACTIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-593-9962
Mailing Address - Street 1:258 NJ 35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-593-9962
Mailing Address - Fax:
Practice Address - Street 1:258 NJ 35 SOUTH
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-592-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00577300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049389U2QMedicare UPIN
NJU85926Medicare UPIN
NJ098498Medicare PIN