=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124553896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAINSPRING CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2017
-----------------------------------------------------
Last Update Date | 05/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 THORNTON RD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07436-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-677-3600
-----------------------------------------------------
Fax | 201-677-3600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 UPPER CROSS RD
-----------------------------------------------------
City | UPPER SADDLE RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07458-2117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-264-7033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN GOULD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 201-264-7033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00709600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------