Provider Demographics
NPI:1487797916
Name:DR. GUTIERREZ CHIROPRACTIC AND HEALTH CENTER LLC,
Entity type:Organization
Organization Name:DR. GUTIERREZ CHIROPRACTIC AND HEALTH CENTER LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:908-834-1209
Mailing Address - Street 1:108 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2807
Mailing Address - Country:US
Mailing Address - Phone:908-834-1209
Mailing Address - Fax:
Practice Address - Street 1:108 JOHN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2807
Practice Address - Country:US
Practice Address - Phone:908-834-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00633700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty