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General NPI Number Information
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NPI Number | 1871850354
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Entity Type | Organization
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Legal Business Name | BLOOMINGDALE CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 235 UNION AVE
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City | BLOOMINGDALE
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State | NJ
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Zip | 07403-1924
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Country | US
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Telephone | 973-492-1568
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Fax | 973-492-0279
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Provider Business Mailing Address
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Address Line | 235 UNION AVE
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City | BLOOMINGDALE
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State | NJ
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Zip | 07403-1924
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Country | US
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Telephone | 973-492-1568
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Fax | 973-492-0279
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | DR. GEORGE EVERETT BREWSTER JR.
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Credential | D.C.
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Telephone | 973-492-1568
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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 | 00203800
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License Number State | NJ
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