1982822524 NPI number — CHIROPRACTORS ON THE MOVE, LLP

Table of content: (NPI 1982822524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982822524 NPI number — CHIROPRACTORS ON THE MOVE, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTORS ON THE MOVE, LLP
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:
6
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:
1982822524
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:
50 HIGHTSTOWN RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
PRINCETON JUNCTION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08550-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-897-1200
Provider Business Mailing Address Fax Number:
609-897-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 HIGHTSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PRINCETON JUNCTION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08550-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-897-1200
Provider Business Practice Location Address Fax Number:
609-897-0900
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEITCH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-897-1200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  MC 05659 , 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)

  • Identifier: 5043 . This is a "GA LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: X009747 . This is a "NY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CH6617 . This is a "FL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: MC 05659 . This is a "NJ LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0027634 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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