Healthcare Provider Details

I. General information

NPI: 1093179137
Provider Name (Legal Business Name): SPINAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 MAIN AVE SUITE 1G
CLIFTON NJ
07011-2252
US

IV. Provider business mailing address

PO BOX 7036
WEST ORANGE NJ
07052-7036
US

V. Phone/Fax

Practice location:
  • Phone: 973-742-0927
  • Fax: 888-373-2114
Mailing address:
  • Phone: 973-742-0927
  • Fax: 888-373-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number38MC00673900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00673900
License Number StateNJ

VIII. Authorized Official

Name: MR. MARCO A LOPEZ
Title or Position: PARTNER
Credential: DC
Phone: 973-742-0927