Healthcare Provider Details

I. General information

NPI: 1093880163
Provider Name (Legal Business Name): COMPLETE CHIROPRACTIC AND REHAB OF MENDHAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WASHINGTON ST
MORRISTOWN NJ
07960-8616
US

IV. Provider business mailing address

PO BOX 177
MENDHAM NJ
07945-0177
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-1110
  • Fax:
Mailing address:
  • Phone: 973-543-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00394600
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID BRIAN SPRIET
Title or Position: OWNER
Credential: D.C.
Phone: 973-543-1110