# PRIME SPINECARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215395132
- **Authorized official:** DR. CHANG PARK (MD/PRESIDENT)
- **Authorized official phone:** (201) 482-0439

## Contact information

- **Practice address:** 118 BROAD AVE STE N9, PALISADES PARK, NJ 07650-2721
- **Practice address phone:** (201) 482-0439
- **Practice address fax:** (201) 482-8703
- **Mailing address:** 118 BROAD AVE STE N9, PALISADES PARK, NJ 07650-2721
- **Mailing address phone:** (201) 482-0439
- **Mailing address fax:** (201) 482-8703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 38MC00733100 | NJ | Yes |

## Other

- **Enumeration date:** 02/05/2016
- **Last updated:** 03/07/2016