Healthcare Provider Details

I. General information

NPI: 1922060854
Provider Name (Legal Business Name): HAINESPORT CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MARNE HIGHWAY
HAINESPORT NJ
08036
US

IV. Provider business mailing address

2717 MARNE HIGHWAY
HAINESPORT NJ
08036
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5550
  • Fax: 609-267-3535
Mailing address:
  • Phone: 609-267-5550
  • Fax: 609-267-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00132300
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN E LONGO
Title or Position: PRESIDENT
Credential: DC
Phone: 609-267-5550