Provider Demographics
NPI:1932866670
Name:DALE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DALE FAMILY 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:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-444-3004
Mailing Address - Street 1:6 STONY HILL CT
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1936
Mailing Address - Country:US
Mailing Address - Phone:201-919-1073
Mailing Address - Fax:
Practice Address - Street 1:666 GODWIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1463
Practice Address - Country:US
Practice Address - Phone:201-444-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty