Healthcare Provider Details

I. General information

NPI: 1093877904
Provider Name (Legal Business Name): SICKLERVILLE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SICKLERVILLE RD
SICKLERVILLE NJ
08081-2626
US

IV. Provider business mailing address

504 SICKLERVILLE RD
SICKLERVILLE NJ
08081-2626
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-1515
  • Fax:
Mailing address:
  • Phone: 856-875-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMC03689
License Number StateNJ

VIII. Authorized Official

Name: DR. GREGORY BIGGIANI
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 856-875-1515