Healthcare Provider Details

I. General information

NPI: 1720812712
Provider Name (Legal Business Name): ELITE CHIRO AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 CROOKS AVE
CLIFTON NJ
07011-1074
US

IV. Provider business mailing address

71 CROOKS AVE
CLIFTON NJ
07011-1074
US

V. Phone/Fax

Practice location:
  • Phone: 973-753-2820
  • Fax: 973-753-2822
Mailing address:
  • Phone: 973-753-2820
  • Fax: 973-753-2822

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: DR. MARIO V MARASOVIC
Title or Position: OWNER
Credential: DC
Phone: 973-758-2820