Healthcare Provider Details

I. General information

NPI: 1154835734
Provider Name (Legal Business Name): ESPORTS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2017
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 FISCHER BLVD
TOMS RIVER NJ
08753-3088
US

IV. Provider business mailing address

210 E FLAMINGO RD UNIT 120
LAS VEGAS NV
89169-4797
US

V. Phone/Fax

Practice location:
  • Phone: 732-444-8114
  • Fax:
Mailing address:
  • Phone: 908-692-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00736700
License Number StateNJ

VIII. Authorized Official

Name: DR. COREY J. CSAKAI
Title or Position: OWNER
Credential: DC
Phone: 908-692-3460