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General NPI Number Information
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NPI Number | 1174008486
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Entity Type | Organization
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Legal Business Name | PAIN PERFORMANCE CHIROPRACTIC HEALTH LLC
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 2116 HIGHWAY 70
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City | MANCHESTER
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State | NJ
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Zip | 08759-4734
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Country | US
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Telephone | 732-657-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 260 SKY MANOR BLVD
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City | BRICK
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State | NJ
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Zip | 08723-6873
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Country | US
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Telephone | 917-841-2445
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | LANCE A NEMIROFF
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Credential | DC
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Telephone | 179-841-2445
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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 |
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License Number State |
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