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General NPI Number Information
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NPI Number | 1659311330
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Entity Type | Organization
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Legal Business Name | CHIROMED-21PC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 880 MONTUA PIKE UNIT C
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City | WOODBURY HEIGHTS
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State | NJ
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Zip | 08097
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Country | US
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Telephone | 856-718-9922
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Fax | 856-848-8208
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Provider Business Mailing Address
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Address Line | P.O. BOX 5581
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City | DEPTFORD
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State | NJ
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Zip | 08096
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Country | US
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Telephone | 856-718-9922
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Fax | 856-848-8208
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Authorized Official
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Title or Position | OWNER
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Name | DR. FRANK RICHARD GASPAROVIC JR.
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Credential | DC
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Telephone | 856-718-9922
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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 | 38MC00444700
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License Number State | NJ
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