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General NPI Number Information
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NPI Number | 1073642955
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Entity Type | Organization
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Legal Business Name | SALEM COUNTY CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 133C NORTH BROADWAY
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City | PENNSVILLE
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State | NJ
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Zip | 08070
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Country | US
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Telephone | 856-678-6607
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Fax | 856-678-6870
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Provider Business Mailing Address
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Address Line | 133C NORTH BROADWAY
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City | PENNSVILLE
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State | NJ
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Zip | 08070
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Country | US
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Telephone | 856-678-6607
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Fax | 856-678-6870
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | MR. IVAN M NADLER
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Credential | DC
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Telephone | 856-678-6607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00216500
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License Number State | NJ
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