Healthcare Provider Details

I. General information

NPI: 1760492573
Provider Name (Legal Business Name): DHCC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 ROUTE 130 N SUITE 200
CINNAMINSON NJ
08077-3035
US

IV. Provider business mailing address

2800 ROUTE 130 N
CINNAMINSON NJ
08077-3035
US

V. Phone/Fax

Practice location:
  • Phone: 856-786-2600
  • Fax: 856-786-2601
Mailing address:
  • Phone: 856-786-2600
  • Fax: 856-786-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00553800
License Number StateNJ

VIII. Authorized Official

Name: TODD BOGOS
Title or Position: OWNER
Credential: D.C
Phone: 856-786-2600