Healthcare Provider Details

I. General information

NPI: 1184829970
Provider Name (Legal Business Name): CIVIL CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 STATE RT 515
VERNON NJ
07462-3027
US

IV. Provider business mailing address

414 STATE ROUTE 515
VERNON NJ
07462-3027
US

V. Phone/Fax

Practice location:
  • Phone: 973-764-6800
  • Fax: 973-764-6800
Mailing address:
  • Phone: 973-764-6800
  • Fax: 973-764-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC05095
License Number StateNJ

VIII. Authorized Official

Name: DR. PATRICIA CIVIL
Title or Position: OWNER
Credential: D.C.
Phone: 973-764-6800