=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093880163
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE CHIROPRACTIC AND REHAB OF MENDHAM, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 04/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 WASHINGTON ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-8616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-543-1110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 177
-----------------------------------------------------
City | MENDHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07945-0177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-543-1110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID BRIAN SPRIET
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 973-543-1110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 38MC00394600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------