Healthcare Provider Details

I. General information

NPI: 1295235091
Provider Name (Legal Business Name): SHORE CHIROPRACTIC AND ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WHITE RD STE 205
LITTLE SILVER NJ
07739-1166
US

IV. Provider business mailing address

180 WHITE RD STE 205
LITTLE SILVER NJ
07739-1166
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-4412
  • Fax:
Mailing address:
  • Phone: 732-842-4412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00258800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00064800
License Number StateNJ

VIII. Authorized Official

Name: JOSEPH R SCAPICIO
Title or Position: OWNER
Credential: DC
Phone: 732-842-4412