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General NPI Number Information
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NPI Number | 1629618020
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Entity Type | Organization
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Legal Business Name | MUNDIE CHIROPRACTIC
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 2 GARFIELD AVE
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City | TOMS RIVER
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State | NJ
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Zip | 08753-7172
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Country | US
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Telephone | 732-503-8332
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Fax |
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Provider Business Mailing Address
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Address Line | 312 PROSPECT AVE
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City | PINE BEACH
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State | NJ
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Zip | 08741-1045
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Country | US
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Telephone | 732-503-8332
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ERIC MUNDIE
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Credential | DC
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Telephone | 732-503-8332
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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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