Healthcare Provider Details

I. General information

NPI: 1548321912
Provider Name (Legal Business Name): SCHICK CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 CLEVELAND AVENUE
HIGHLAND PARK NJ
08904
US

IV. Provider business mailing address

317 CLEVELAND AVENUE
HIGHLAND PARK NJ
08904
US

V. Phone/Fax

Practice location:
  • Phone: 732-249-9800
  • Fax: 732-249-6300
Mailing address:
  • Phone: 732-249-9800
  • Fax: 732-249-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAKIRA DEROCHE
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-249-9800