Provider Demographics
NPI:1982827812
Name:MOUNT PROSPECT CHIROPRACTICE CENTER
Entity Type:Organization
Organization Name:MOUNT PROSPECT CHIROPRACTICE CENTER
Other - Org Name:MOUNT PROSPECT HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCSWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-485-2332
Mailing Address - Street 1:600 MOUNT PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1531
Mailing Address - Country:US
Mailing Address - Phone:973-485-2332
Mailing Address - Fax:973-485-6878
Practice Address - Street 1:600 MOUNT PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1531
Practice Address - Country:US
Practice Address - Phone:973-485-2332
Practice Address - Fax:973-485-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
091894Medicare PIN