Healthcare Provider Details

I. General information

NPI: 1124030721
Provider Name (Legal Business Name): UNION CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CHESTNUT ST STE C
UNION NJ
07083-9306
US

IV. Provider business mailing address

418 CHESTNUT ST STE C
UNION NJ
07083-9306
US

V. Phone/Fax

Practice location:
  • Phone: 908-810-9002
  • Fax: 908-810-9012
Mailing address:
  • Phone: 908-810-9002
  • Fax: 908-810-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00603500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01162800
License Number StateNJ

VIII. Authorized Official

Name: DR. JEANINE GOLDEN
Title or Position: OWNER
Credential:
Phone: 908-810-9002