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General NPI Number Information
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NPI Number | 1255427423
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Entity Type | Organization
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Legal Business Name | COLONIAL VALLEY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 136 LAWRENCEVILLE PENNING RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1413
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Country | US
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Telephone | 609-912-0062
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Fax | 609-912-0064
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Provider Business Mailing Address
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Address Line | 136 LAWRENCEVILLE PENNING RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1413
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Country | US
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Telephone | 609-912-0062
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Fax | 609-912-0064
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MICHAEL RILEY MCCUE JR.
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Credential | D.C.
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Telephone | 609-912-0062
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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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