Healthcare Provider Details

I. General information

NPI: 1750396149
Provider Name (Legal Business Name): INTEGRATED CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NORTH AVE EAST
WESTFIELD NJ
07090
US

IV. Provider business mailing address

425 NORTH AVE EAST
WESTFIELD NJ
07090
US

V. Phone/Fax

Practice location:
  • Phone: 908-789-3400
  • Fax: 908-654-9286
Mailing address:
  • Phone: 908-789-3400
  • Fax: 908-654-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC00353600
License Number StateNJ

VIII. Authorized Official

Name: DR. JEFFREY PAUL KAVALIN
Title or Position: OWNER
Credential: DC
Phone: 908-789-3400