Healthcare Provider Details

I. General information

NPI: 1609950864
Provider Name (Legal Business Name): BRIAN FRANCIS CIVINSKI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 NOTTINGHAM WAY
HAMILTON NJ
08619-1844
US

IV. Provider business mailing address

3105 NOTTINGHAM WAY
HAMILTON NJ
08619-1844
US

V. Phone/Fax

Practice location:
  • Phone: 609-631-7200
  • Fax: 609-631-9363
Mailing address:
  • Phone: 609-631-7200
  • Fax: 609-631-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00516500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: