Healthcare Provider Details

I. General information

NPI: 1376852798
Provider Name (Legal Business Name): PASSAIC FAMILY CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 MAIN AVE STE 202
PASSAIC NJ
07055-4962
US

IV. Provider business mailing address

647 MAIN AVE STE 202
PASSAIC NJ
07055-4962
US

V. Phone/Fax

Practice location:
  • Phone: 973-778-2300
  • Fax: 973-778-2311
Mailing address:
  • Phone: 973-778-2300
  • Fax: 973-778-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIE A ADDESA
Title or Position: PRESIDENT
Credential: APN, DC
Phone: 908-456-0060