Provider Demographics
NPI:1750813200
Name:CHIROPRACTIC HEALTH CLINIC OF STEWARTSVILLE LLC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CLINIC OF STEWARTSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-454-2666
Mailing Address - Street 1:P.O. BOX 26
Mailing Address - Street 2:725 ROUTE 57
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886
Mailing Address - Country:US
Mailing Address - Phone:908-454-2666
Mailing Address - Fax:908-454-3315
Practice Address - Street 1:725 ROUTE 57
Practice Address - Street 2:
Practice Address - City:STEWARTSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08886
Practice Address - Country:US
Practice Address - Phone:908-454-2666
Practice Address - Fax:908-454-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU70314Medicare UPIN