Provider Demographics
NPI:1730362591
Name:ENHANCED CHIROPRACTIC CORP
Entity type:Organization
Organization Name:ENHANCED CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KOLONICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-714-1107
Mailing Address - Street 1:30 JACKSON RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 JACKSON RD
Practice Address - Street 2:SUITE A1
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9283
Practice Address - Country:US
Practice Address - Phone:609-714-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00633400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1730362591OtherNPI
NJ2765346000OtherPERSONAL CHOICE
NJ119956OtherMEDICARE GROUP
NJ2765346000OtherAMERIHEALTH
NJ2765346000OtherKEYSTONE HPE