Provider Demographics
NPI:1982975991
Name:DANIEL CHIROPRACTIC OF WOODCLIFF LAKE, PC
Entity Type:Organization
Organization Name:DANIEL CHIROPRACTIC OF WOODCLIFF LAKE, PC
Other - Org Name:PARK RIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:N
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-364-1289
Mailing Address - Street 1:75 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656
Mailing Address - Country:US
Mailing Address - Phone:201-364-1289
Mailing Address - Fax:201-746-0551
Practice Address - Street 1:75 PARK AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656
Practice Address - Country:US
Practice Address - Phone:201-364-1289
Practice Address - Fax:201-746-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00680400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty