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General NPI Number Information
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NPI Number | 1740412352
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Entity Type | Organization
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Legal Business Name | GANTTOWN CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 122 GANTTOWN RD
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1677
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Country | US
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Telephone | 856-227-1911
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Fax | 856-228-9681
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Provider Business Mailing Address
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Address Line | 122 GANTTOWN RD
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1677
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Country | US
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Telephone | 856-227-1911
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Fax | 856-228-9681
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Authorized Official
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Title or Position | CEO
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Name | DR. PAUL DAVIDSON
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Credential | D.C.
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Telephone | 856-227-1911
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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 | 38MC00184600
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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 | 38MC00633600
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License Number State | NJ
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