Healthcare Provider Details

I. General information

NPI: 1972692747
Provider Name (Legal Business Name): BRUCE CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 STATION AVENUE
HADDON HTS NJ
08035-1647
US

IV. Provider business mailing address

708 STATION AVENUE BRUCE CHIROPRACTIC CENTER LLC
HADDON HTS NJ
08035-1647
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-6587
  • Fax: 856-547-6995
Mailing address:
  • Phone: 856-547-6587
  • Fax: 856-547-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00648600
License Number StateNJ

VIII. Authorized Official

Name: DR. JEFFREY S ZUIDEMA
Title or Position: DC OWNER
Credential: DC
Phone: 856-547-6587