Healthcare Provider Details

I. General information

NPI: 1497084537
Provider Name (Legal Business Name): KNICKERBOCKER CHIROPRACTIC CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 KNICKERBOCKER RD
DEMAREST NJ
07627-1904
US

IV. Provider business mailing address

27 KNICKERBOCKER RD
DEMAREST NJ
07627-1904
US

V. Phone/Fax

Practice location:
  • Phone: 201-768-6605
  • Fax: 201-768-0667
Mailing address:
  • Phone: 201-768-6605
  • Fax: 201-768-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00242800
License Number StateNJ

VIII. Authorized Official

Name: DR. THERESE A FRANKLIN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 201-768-6605