Healthcare Provider Details

I. General information

NPI: 1174756589
Provider Name (Legal Business Name): THE CHIROPRACTIC SOURCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 POMPTON AVE
CEDAR GROVE NJ
07009-1814
US

IV. Provider business mailing address

388 POMPTON AVE
CEDAR GROVE NJ
07009-1814
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-0500
  • Fax: 973-228-0501
Mailing address:
  • Phone: 973-228-0500
  • Fax: 973-228-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00676300
License Number StateNJ

VIII. Authorized Official

Name: DR. MARCO FERRUCCI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 973-477-8414