Organization
ADAVANCED SPINE REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN LATZA DC (DIRECTGOR)
(908) 558-9500
Entity
Organization
Contact information
Practice address
1171 OLD RARITAN RD, CLARK, NJ 07066
(908) 558-9500
(908) 344-5557
Mailing address
1171 OLD RARITAN RD, CLARK, NJ 07066
(908) 558-9500
(908) 344-5557
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
38MC00398100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003949256
NPI
NJ
01
—
120505108
NPI
NJ
Enumeration date
11/24/2014
Last updated
11/24/2014
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