Healthcare Provider Details

I. General information

NPI: 1285635003
Provider Name (Legal Business Name): GLASSBORO CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N MAIN ST
GLASSBORO NJ
08028-1633
US

IV. Provider business mailing address

405 N MAIN ST
GLASSBORO NJ
08028-1633
US

V. Phone/Fax

Practice location:
  • Phone: 856-881-8811
  • Fax: 856-881-9152
Mailing address:
  • Phone: 856-881-8811
  • Fax: 856-881-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMCO3747
License Number StateNJ

VIII. Authorized Official

Name: DR. PHILLIP ALLEN SHERMAN
Title or Position: PARTNER
Credential: D.C.
Phone: 856-881-8811