Provider Demographics
NPI:1548321912
Name:SCHICK CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:SCHICK CHIROPRACTIC CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-249-9800
Mailing Address - Street 1:317 CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904
Mailing Address - Country:US
Mailing Address - Phone:732-249-9800
Mailing Address - Fax:732-249-6300
Practice Address - Street 1:317 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904
Practice Address - Country:US
Practice Address - Phone:732-249-9800
Practice Address - Fax:732-249-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111NX0800X, 171100000X, 225100000X, 261QM2500X
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138367OtherGHI
NJDF5850OtherRAILROAD MEDICARE
NJ107866Medicare PIN