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General NPI Number Information
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NPI Number | 1588679906
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Entity Type | Organization
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Legal Business Name | PRINCETON CHIROPRACTIC CENTER, L.L.C.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 601 EWING ST SUITE C-3
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City | PRINCETON
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State | NJ
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Zip | 08540-2757
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Country | US
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Telephone | 609-921-1705
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Fax |
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Provider Business Mailing Address
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Address Line | 601 EWING ST SUITE C-3
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City | PRINCETON
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State | NJ
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Zip | 08540-2757
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Country | US
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Telephone | 609-921-1705
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | DR. EDWARD VINCENT SOFO
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Credential | D.C., C.C.S.P.
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Telephone | 609-921-1705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | MC3749
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License Number State | NJ
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