Healthcare Provider Details

I. General information

NPI: 1124313531
Provider Name (Legal Business Name): ATLANTIC COAST CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BRICK BLVD STE 104
BRICK NJ
08723-7984
US

IV. Provider business mailing address

74 BRICK BLVD STE 104
BRICK NJ
08723-7984
US

V. Phone/Fax

Practice location:
  • Phone: 732-477-5888
  • Fax:
Mailing address:
  • Phone: 732-477-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARL SULSENTI
Title or Position: MEMBER
Credential:
Phone: 732-477-5888