Healthcare Provider Details

I. General information

NPI: 1609708478
Provider Name (Legal Business Name): IMMACULATE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 AVENUE C
BAYONNE NJ
07002-3704
US

IV. Provider business mailing address

546 AVENUE C
BAYONNE NJ
07002-3704
US

V. Phone/Fax

Practice location:
  • Phone: 516-388-8960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: IMMACULATE ORLANDO
Title or Position: OWNER
Credential:
Phone: 516-388-8960