Healthcare Provider Details

I. General information

NPI: 1184371684
Provider Name (Legal Business Name): MORA CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 N 13TH ST
NEWARK NJ
07107-1317
US

IV. Provider business mailing address

PO BOX 189
HARRINGTON PARK NJ
07640-0189
US

V. Phone/Fax

Practice location:
  • Phone: 862-237-9898
  • Fax: 862-237-9897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH S NIERODA
Title or Position: PRESIDENT
Credential: DC
Phone: 862-237-9896