Healthcare Provider Details

I. General information

NPI: 1417127234
Provider Name (Legal Business Name): JAMES SANTIAGO DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 VANBUREN STREET
NEWARK NJ
07105
US

IV. Provider business mailing address

132 VANBUREN STREET
NEWARK NJ
07105
US

V. Phone/Fax

Practice location:
  • Phone: 973-344-7777
  • Fax: 973-344-2223
Mailing address:
  • Phone: 973-344-7777
  • Fax: 973-344-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES JOSEPH SANTIAGO
Title or Position: OWNER
Credential: D.C. L.AC
Phone: 973-344-7777