Healthcare Provider Details

I. General information

NPI: 1205112760
Provider Name (Legal Business Name): DHCC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MADISON AVE
LUMBERTON NJ
08048-2901
US

IV. Provider business mailing address

15 BURNT MILL RD SUITE D
CHERRY HILL NJ
08003-3947
US

V. Phone/Fax

Practice location:
  • Phone: 877-222-5203
  • Fax: 609-261-7562
Mailing address:
  • Phone: 856-429-7200
  • Fax: 856-429-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00580900
License Number StateNJ

VIII. Authorized Official

Name: JUDIE COMERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-429-7200