Provider Demographics
NPI:1669746582
Name:SPINE & BALANCE CENTER OF NJ, LLC
Entity type:Organization
Organization Name:SPINE & BALANCE CENTER OF NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NIXDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-207-5322
Mailing Address - Street 1:179 CEDAR LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4304
Mailing Address - Country:US
Mailing Address - Phone:201-907-5092
Mailing Address - Fax:201-907-0031
Practice Address - Street 1:179 CEDAR LN STE B
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4304
Practice Address - Country:US
Practice Address - Phone:201-907-5092
Practice Address - Fax:201-596-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U57712Medicare UPIN
NJ796380Medicare PIN