Provider Demographics
NPI:1043102445
Name:IMMACULATE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:IMMACULATE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-302-6676
Mailing Address - Street 1:901 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3012
Mailing Address - Country:US
Mailing Address - Phone:516-388-8960
Mailing Address - Fax:551-302-6862
Practice Address - Street 1:901 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3012
Practice Address - Country:US
Practice Address - Phone:516-388-8960
Practice Address - Fax:551-302-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation