Provider Demographics
NPI:1982784732
Name:JOHNSON CHIROPRACTIC ASSOCIATES
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC ASSOCIATES
Other - Org Name:MANCUSO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-521-0679
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-0160
Mailing Address - Country:US
Mailing Address - Phone:732-521-0679
Mailing Address - Fax:732-521-0168
Practice Address - Street 1:315 FORSGATE DR
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1539
Practice Address - Country:US
Practice Address - Phone:732-521-0679
Practice Address - Fax:732-521-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU85138Medicare UPIN
NJ062996Medicare ID - Type Unspecified