Provider Demographics
NPI:1487812111
Name:FUTURE CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:FUTURE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-374-1200
Mailing Address - Street 1:501 ROUTE 168
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1458
Mailing Address - Country:US
Mailing Address - Phone:856-374-1200
Mailing Address - Fax:856-401-3122
Practice Address - Street 1:501 ROUTE 168
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1458
Practice Address - Country:US
Practice Address - Phone:856-374-1200
Practice Address - Fax:856-401-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00257300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU42727Medicare UPIN
NJ513518Medicare PIN