Healthcare Provider Details

I. General information

NPI: 1669746582
Provider Name (Legal Business Name): SPINE & BALANCE CENTER OF NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 CEDAR LN STE B
TEANECK NJ
07666-4304
US

IV. Provider business mailing address

179 CEDAR LN SUITE F
TEANECK NJ
07666-4304
US

V. Phone/Fax

Practice location:
  • Phone: 201-907-5092
  • Fax: 201-596-3630
Mailing address:
  • Phone: 201-907-5092
  • Fax: 201-907-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. KARL WILLIAM NIXDORF
Title or Position: MANAGING PARTNER
Credential: D.C.
Phone: 201-207-5322