Healthcare Provider Details

I. General information

NPI: 1669368031
Provider Name (Legal Business Name): PREMIER CHIRO AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GREENBROOK RD STE 5
NORTH PLAINFIELD NJ
07060-3903
US

IV. Provider business mailing address

PO BOX 188
CLIFTON NJ
07015-0188
US

V. Phone/Fax

Practice location:
  • Phone: 973-809-2620
  • Fax:
Mailing address:
  • Phone: 973-809-2620
  • 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: SEAN MARTIN NISIVOCCIA
Title or Position: OWNER
Credential:
Phone: 973-809-2620