Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00131400 | NJ |
NPI | 1003961004 |
---|---|
Provider Name | Dr. Alan S Pine |
First Address | Englewood, NJ 07631-2501 |
Second Address | Englewood, NJ 07631-2501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 11/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5451001 | (05) | NJ |
T44643 | (02) |