=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639428188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE CHIROPRACTIC CLINIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2012
-----------------------------------------------------
Last Update Date | 08/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48 UNION BLVD
-----------------------------------------------------
City | WALLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07057-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-470-9900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 UNION BLVD
-----------------------------------------------------
City | WALLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07057-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-470-9900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ZBIGNIEW S. DUBIJ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 973-470-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00545800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------