Healthcare Provider Details

I. General information

NPI: 1861546970
Provider Name (Legal Business Name): XCALIBUR CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MADISON AVE
LUMBERTON NJ
08048-2901
US

IV. Provider business mailing address

227 MADISON AVE
LUMBERTON NJ
08048-2901
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-7562
  • Fax:
Mailing address:
  • Phone: 609-261-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCO09080-5B
License Number StateNY

VIII. Authorized Official

Name: XERXES OSHIDAR
Title or Position: PRESIDENT
Credential: DC
Phone: 609-261-7562