Provider Demographics
NPI:1770762056
Name:BAVER AND CORDUAN FAMILY CHIROPRACTIC HEALTH CENTER P.C.
Entity type:Organization
Organization Name:BAVER AND CORDUAN FAMILY CHIROPRACTIC HEALTH CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CORDUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-855-8522
Mailing Address - Street 1:1 WOODBRIDGE CTR
Mailing Address - Street 2:SUITE 245
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1150
Mailing Address - Country:US
Mailing Address - Phone:732-855-8522
Mailing Address - Fax:732-634-7920
Practice Address - Street 1:1 WOODBRIDGE CTR
Practice Address - Street 2:SUITE 245
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1150
Practice Address - Country:US
Practice Address - Phone:732-855-8522
Practice Address - Fax:732-634-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU18966Medicare UPIN