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General NPI Number Information
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NPI Number | 1255520888
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Entity Type | Organization
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Legal Business Name | MONMOUTH FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 740 BROAD ST MONMOUTH FAMILY CHIROPRACTIC PC
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City | SHREWSBURY
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State | NJ
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Zip | 07702
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Country | US
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Telephone | 732-530-7711
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Fax | 730-530-9708
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Provider Business Mailing Address
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Address Line | PO BOX 7425 MONMOUTH FAMILY CHIROPRACTIC
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City | SHREWBURY
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State | NJ
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Zip | 07702
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Country | US
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Telephone | 735-307-7111
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Fax | 732-530-9708
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Authorized Official
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Title or Position | PRES OF CORP CHIROPRACTOR
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Name | DR. ERICK WALDEMAR HENDERIKS
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Credential | DC
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Telephone | 732-530-7711
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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 | MC3021
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License Number State | NJ
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