Healthcare Provider Details

I. General information

NPI: 1881834976
Provider Name (Legal Business Name): JOHN R BILAS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN BILAS D.C.

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 BRINLEY AVE
BRADLEY BEACH NJ
07720-1312
US

IV. Provider business mailing address

514 BRINLEY AVE
BRADLEY BEACH NJ
07720-1312
US

V. Phone/Fax

Practice location:
  • Phone: 609-204-2092
  • Fax:
Mailing address:
  • Phone: 609-204-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2715
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number36MC00208000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: