Healthcare Provider Details

I. General information

NPI: 1295875482
Provider Name (Legal Business Name): WALDWICK FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 FRANKLIN TPKE
WALDWICK NJ
07463-1820
US

IV. Provider business mailing address

93 FRANKLIN TPKE
WALDWICK NJ
07463-1820
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-8091
  • Fax:
Mailing address:
  • Phone: 201-445-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00653300
License Number StateNJ

VIII. Authorized Official

Name: ANDREW MATASSA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 201-445-8091