Organization
BACK PAIN REHAB CENTER FOR TREATMENT OF BACK PAIN LLC
Active
Other names
BACK PAIN REHAB LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN N COLLAZO D.C. (DIRECTOR)
(201) 750-7246
Entity
Organization
Contact information
Practice address
12 WORTENDYKE RD, PARK RIDGE, NJ 07656-2046
(201) 750-7246
Mailing address
12 WORTENDYKE RD, PARK RIDGE, NJ 07656-2046
(201) 750-7246
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
38MC00430900
NJ
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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