Provider Demographics
NPI:1912066606
Name:ABC CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ABC CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:O
Authorized Official - Last Name:SPEZIALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-440-6686
Mailing Address - Street 1:17 WINANT AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1925
Mailing Address - Country:US
Mailing Address - Phone:201-440-6686
Mailing Address - Fax:
Practice Address - Street 1:17 WINANT AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-1925
Practice Address - Country:US
Practice Address - Phone:201-440-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00542100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU87519Medicare UPIN
NJ052188Medicare ID - Type Unspecified