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General NPI Number Information
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NPI Number | 1710176672
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Entity Type | Organization
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Legal Business Name | PINE CONE CHIROPRACTIC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 10 PINE CONE LANE
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City | SPARTA
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State | NJ
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Zip | 07871-2302
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Country | US
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Telephone | 973-729-5251
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Fax | 972-729-1431
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Provider Business Mailing Address
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Address Line | 10 PINE CONE LANE
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City | SPARTA
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State | NJ
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Zip | 07871-2302
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Country | US
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Telephone | 973-729-5251
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Fax | 972-729-1431
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | ANNE M ODAIR
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Credential | DC
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Telephone | 973-729-5251
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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 | MC04860
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | MC05169
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License Number State | NJ
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