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General NPI Number Information
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NPI Number | 1336355205
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Entity Type | Organization
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Legal Business Name | EATONTOWN ELITE CARE CENTER, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 SOUTH ST
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City | EATONTOWN
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State | NJ
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Zip | 07724-3405
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Country | US
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Telephone | 732-389-2800
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Fax | 732-389-0246
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Provider Business Mailing Address
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Address Line | 40 SOUTH ST
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City | EATONTOWN
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State | NJ
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Zip | 07724-3405
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Country | US
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Telephone | 732-389-2800
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Fax | 732-389-0246
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Authorized Official
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Title or Position | OWNER AND SOLE MEMBER
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Name | DR. JORDAN LOUIS KOVACS
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Credential | D.C.
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Telephone | 732-389-2800
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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 | 38MC00593000
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License Number State | NJ
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