Healthcare Provider Details

I. General information

NPI: 1083854566
Provider Name (Legal Business Name): PREMIER HEALTH OF SUMMIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAPLE ST SUITE 103
SUMMIT NJ
07901-2571
US

IV. Provider business mailing address

47 MAPLE ST SUITE 103
SUMMIT NJ
07901-2571
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-1003
  • Fax: 973-839-3653
Mailing address:
  • Phone: 973-839-1003
  • Fax: 973-839-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00656700
License Number StateNJ

VIII. Authorized Official

Name: BRIAN ANDERSON
Title or Position: OWNER
Credential: DC
Phone: 973-839-1003