Healthcare Provider Details

I. General information

NPI: 1093201220
Provider Name (Legal Business Name): NEW VERNON CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VILLAGE ROAD
NEW VERNON NJ
07976-0009
US

IV. Provider business mailing address

PO BOX 9
NEW VERNON NJ
07976-0009
US

V. Phone/Fax

Practice location:
  • Phone: 973-984-5200
  • Fax: 973-984-3020
Mailing address:
  • Phone: 973-984-5200
  • Fax: 973-984-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00223500
License Number StateNJ

VIII. Authorized Official

Name: DR. EILEEN KLOK BEVAN
Title or Position: OWNER
Credential: DC
Phone: 973-984-5200