Provider Demographics
NPI:1912089186
Name:WALL CHIROPRACTIC CENTER,P.C.
Entity Type:Organization
Organization Name:WALL CHIROPRACTIC CENTER,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUERKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-681-7766
Mailing Address - Street 1:2510 BELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3948
Mailing Address - Country:US
Mailing Address - Phone:732-681-7766
Mailing Address - Fax:732-681-7511
Practice Address - Street 1:2510 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3948
Practice Address - Country:US
Practice Address - Phone:732-681-7766
Practice Address - Fax:732-681-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45341Medicare UPIN
NJ453507Medicare ID - Type UnspecifiedMEDICARE NUMBER