Healthcare Provider Details

I. General information

NPI: 1831276633
Provider Name (Legal Business Name): LANCE ALAN NEMIROFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 ROUTE 70
MANCHESTER NJ
08759-4734
US

IV. Provider business mailing address

2116 ROUTE 70
MANCHESTER NJ
08759-4734
US

V. Phone/Fax

Practice location:
  • Phone: 732-657-2225
  • Fax: 732-657-2598
Mailing address:
  • Phone: 732-857-6922
  • Fax: 732-657-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number00573600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: