Healthcare Provider Details

I. General information

NPI: 1790594810
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC AND REHAD OF ATCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 WHITE HORSE PIKE
ATCO NJ
08004-2227
US

IV. Provider business mailing address

429 WHITE HORSE PIKE
ATCO NJ
08004-2227
US

V. Phone/Fax

Practice location:
  • Phone: 609-560-4088
  • Fax:
Mailing address:
  • Phone: 609-560-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH CLEMENTS
Title or Position: PRESIDENT
Credential: DC
Phone: 609-560-4088