Healthcare Provider Details

I. General information

NPI: 1194882167
Provider Name (Legal Business Name): COMPLETE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 RINGWOOD AVE
WANAQUE NJ
07465-2315
US

IV. Provider business mailing address

498 RINGWOOD AVE
WANAQUE NJ
07465-2315
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-3010
  • Fax: 973-839-3015
Mailing address:
  • Phone: 973-839-3010
  • Fax: 973-839-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00444500
License Number StateNJ

VIII. Authorized Official

Name: DR. CHRISTOPHER JOHN DEMETRIOU
Title or Position: OWNER
Credential: D.C.
Phone: 973-839-3010