Healthcare Provider Details

I. General information

NPI: 1003949256
Provider Name (Legal Business Name): MICHAEL JOHN LATZA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 PARK AVE
PLAINFIELD NJ
07060-1206
US

IV. Provider business mailing address

212 PARK AVE
PLAINFIELD NJ
07060-1206
US

V. Phone/Fax

Practice location:
  • Phone: 908-322-8300
  • Fax: 908-322-8311
Mailing address:
  • Phone: 908-322-8300
  • Fax: 908-322-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00398100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: