Healthcare Provider Details

I. General information

NPI: 1710957808
Provider Name (Legal Business Name): MONTVILLE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 MAIN RD
MONTVILLE NJ
07045
US

IV. Provider business mailing address

381 MAIN RD
MONTVILLE NJ
07045-8600
US

V. Phone/Fax

Practice location:
  • Phone: 973-335-8600
  • Fax: 973-335-2988
Mailing address:
  • Phone: 973-335-8600
  • Fax: 973-335-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number254A
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00128900
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD B STELE
Title or Position: PRESIDENT
Credential: DC
Phone: 973-335-8600