Provider Demographics
NPI:1710010525
Name:CAMP CHIROPRACTIC CARE, LLC
Entity type:Organization
Organization Name:CAMP CHIROPRACTIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-569-0224
Mailing Address - Street 1:2 E PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1424
Mailing Address - Country:US
Mailing Address - Phone:609-569-0224
Mailing Address - Fax:609-407-2122
Practice Address - Street 1:2 E PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1424
Practice Address - Country:US
Practice Address - Phone:609-569-0224
Practice Address - Fax:609-407-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00526200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ039924Medicare ID - Type Unspecified