Provider Demographics
NPI:1730374638
Name:JOINT & SPINE CENTER OF MEDFORD LLC
Entity type:Organization
Organization Name:JOINT & SPINE CENTER OF MEDFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-267-5335
Mailing Address - Street 1:767 E ROUTE 70
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2345
Mailing Address - Country:US
Mailing Address - Phone:856-267-5335
Mailing Address - Fax:856-267-5554
Practice Address - Street 1:767 E ROUTE 70
Practice Address - Street 2:SUITE B-102
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2345
Practice Address - Country:US
Practice Address - Phone:856-267-5335
Practice Address - Fax:856-267-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00510600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty