Provider Demographics
NPI:1861546970
Name:XCALIBUR CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:XCALIBUR CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XERXES
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-261-7562
Mailing Address - Street 1:227 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2901
Mailing Address - Country:US
Mailing Address - Phone:609-261-7562
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2901
Practice Address - Country:US
Practice Address - Phone:609-261-7562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCO09080-5B111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2396001000OtherAMERIHEALTH GROUP
NYXAWPZ1Medicare ID - Type Unspecified
NJ2396001000OtherAMERIHEALTH GROUP