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General NPI Number Information
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NPI Number | 1760782056
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Entity Type | Organization
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Legal Business Name | CLIFTON SPORTS CHIROPRACTIC
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1233 MAIN AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2241
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Country | US
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Telephone | 973-928-1144
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Fax | 973-928-1147
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Provider Business Mailing Address
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Address Line | 1233 MAIN AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2241
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Country | US
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Telephone | 973-928-1144
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Fax | 973-928-1147
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | MR. PETER PONZINI
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Credential | D.C
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Telephone | 551-427-8866
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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 | 38MC00619200
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License Number State | NJ
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