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General NPI Number Information
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NPI Number | 1194882167
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Entity Type | Organization
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Legal Business Name | COMPLETE CHIROPRACTIC PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 498 RINGWOOD AVE
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City | WANAQUE
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State | NJ
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Zip | 07465-2315
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Country | US
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Telephone | 973-839-3010
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Fax | 973-839-3015
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Provider Business Mailing Address
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Address Line | 498 RINGWOOD AVE
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City | WANAQUE
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State | NJ
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Zip | 07465-2315
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Country | US
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Telephone | 973-839-3010
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Fax | 973-839-3015
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER JOHN DEMETRIOU
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Credential | D.C.
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Telephone | 973-839-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 38MC00444500
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License Number State | NJ
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