Healthcare Provider Details

I. General information

NPI: 1689044331
Provider Name (Legal Business Name): PAGE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MEMORIAL PKWY
ATLANTIC HIGHLANDS NJ
07716-1441
US

IV. Provider business mailing address

51 MEMORIAL PKWY
ATLANTIC HIGHLANDS NJ
07716-1441
US

V. Phone/Fax

Practice location:
  • Phone: 732-291-5575
  • Fax: 732-291-5575
Mailing address:
  • Phone: 732-291-5575
  • Fax: 732-291-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00590700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00114800
License Number StateNJ

VIII. Authorized Official

Name: DR. JULIE PAGE
Title or Position: PRESIDENT
Credential: DC
Phone: 732-291-5575