1104956440 NPI number — PANAIA CHIROPRACTIC OF CHERRY HILL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104956440 NPI number — PANAIA CHIROPRACTIC OF CHERRY HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANAIA CHIROPRACTIC OF CHERRY HILL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104956440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1299 BRACE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-795-2424
Provider Business Mailing Address Fax Number:
856-795-2212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1299 BRACE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-795-2424
Provider Business Practice Location Address Fax Number:
856-795-2212
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANAIA
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
856-795-2424

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38ML00430300 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2707432000 . This is a "BCBS AMERI HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0461651 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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