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General NPI Number Information
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NPI Number | 1669988192
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Entity Type | Organization
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Legal Business Name | SUMMIT CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 392 TOTOWA RD
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City | TOTOWA
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State | NJ
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Zip | 07512-2075
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Country | US
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Telephone | 973-942-9400
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Fax | 973-942-9300
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Provider Business Mailing Address
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Address Line | 392 TOTOWA RD
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City | TOTOWA
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State | NJ
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Zip | 07512-2075
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Country | US
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Telephone | 973-942-9400
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Fax | 973-942-9300
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ANTHONY FAVA
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Credential | DC
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Telephone | 973-703-7008
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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 | MC04563
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License Number State | NJ
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