| Sport Rehab Chiro P.c. | |
|
204 Tom Hunter Rd Fort Lee NJ 07024-5302 | |
| (201) 220-2245 | |
| Not Available |
| Full Name | Sport Rehab Chiro P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 204 Tom Hunter Rd, Fort Lee, New Jersey |
| Authorized Official Name and Position | Richard Lee (OWNER) |
| Authorized Official Contact | 2012202245 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sport Rehab Chiro P.c. 204 Tom Hunter Rd Fort Lee NJ 07024-5302 Ph: (201) 220-2245 | Sport Rehab Chiro P.c. 204 Tom Hunter Rd Fort Lee NJ 07024-5302 Ph: (201) 220-2245 |
| NPI Number | 1982366571 |
|---|---|
| Provider Enumeration Date | 10/11/2021 |
| Last Update Date | 01/03/2022 |
| Medicare PECOS PAC ID | 8426441031 |
|---|---|
| Medicare Enrollment ID | O20220203000374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982366571 | NPI | - | NPPES |
| 0450681085 | Other | NJ | IDENTIFICATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Richard Lee |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1467114041 PECOS PAC ID: 5698168201 Enrollment ID: I20220203000583 |
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