Healthcare Provider Details

I. General information

NPI: 1013184308
Provider Name (Legal Business Name): SUMMIT SPINAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W ROUTE 38
MOORESTOWN NJ
08057-3238
US

IV. Provider business mailing address

212 W ROUTE 38
MOORESTOWN NJ
08057-3238
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-1003
  • Fax: 973-839-3653
Mailing address:
  • Phone: 973-839-1003
  • Fax: 973-839-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number38MC00598300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00598300
License Number StateNJ

VIII. Authorized Official

Name: JOSHUA P SHERLOCK
Title or Position: PRESIDENT
Credential: DC
Phone: 973-839-1003