1144494980 NPI number — JUNIOR CHIROPRACTIC CENTER, P.A.

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 1144494980 NPI number — JUNIOR CHIROPRACTIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUNIOR CHIROPRACTIC CENTER, P.A.
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:
DR.DANIEL B JUNIOR III,D.C.
Provider Other Organization Name Type Code:
5
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:
1144494980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
472 RIDGEDALE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HANOVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07936-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-884-1111
Provider Business Mailing Address Fax Number:
973-884-3605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
472 RIDGEDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST HANOVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07936-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-884-1111
Provider Business Practice Location Address Fax Number:
973-884-3605
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JUNIOR
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
BERNARD
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
973-884-1111

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  MC05894 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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