1730322587 NPI number — FAIR LAWN CHIROPRACTIC THERAPY LLC

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 1730322587 NPI number — FAIR LAWN CHIROPRACTIC THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIR LAWN CHIROPRACTIC THERAPY LLC
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:
1730322587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14-25 PLAZA RD
Provider Second Line Business Mailing Address:
SUITE S24
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-3546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-797-7373
Provider Business Mailing Address Fax Number:
973-782-4819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14-25 PLAZA RD
Provider Second Line Business Practice Location Address:
SUITE S24
Provider Business Practice Location Address City Name:
FAIR LAWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07410-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-797-7373
Provider Business Practice Location Address Fax Number:
973-782-4819
Provider Enumeration Date:
04/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KHALAF
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-595-6444

Provider Taxonomy Codes

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

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





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