Healthcare Provider Details

I. General information

NPI: 1760906531
Provider Name (Legal Business Name): TWIN MEADOWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 SHUNPIKE RD
CHATHAM NJ
07928-1659
US

IV. Provider business mailing address

10 COREY LN
MENDHAM NJ
07945-3309
US

V. Phone/Fax

Practice location:
  • Phone: 973-525-7213
  • Fax:
Mailing address:
  • Phone: 973-525-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00735600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00735600
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID LUKE DIJKSTRA
Title or Position: SPORTS CHIROPRACTOR / MEMBER
Credential: DC
Phone: 973-525-7213