Healthcare Provider Details

I. General information

NPI: 1982827812
Provider Name (Legal Business Name): MOUNT PROSPECT CHIROPRACTICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOUNT PROSPECT AVENUE
NEWARK NJ
07104-1531
US

IV. Provider business mailing address

600 MOUNT PROSPECT AVENUE
NEWARK NJ
07104-1531
US

V. Phone/Fax

Practice location:
  • Phone: 973-485-2332
  • Fax: 973-485-6878
Mailing address:
  • Phone: 973-485-2332
  • Fax: 973-485-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY M MCSWEENEY
Title or Position: PRESIDENT
Credential:
Phone: 973-485-2332