South Shore Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

MC03565 Issued in NJ

Legal business name

SOUTH SHORE CHIROPRACTIC LLC

Practice address

1217 Route 9
Suite 101
Palermo, NJ 08230

Phone

(609) 390-8772

Fax

(609) 390-8699

NPI assigned

Nov 17, 2010

Last updated

Nov 17, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary R Mruz, DCNPI 1649218413

Title

Owner Chiropractor

Phone

(609) 390-8772

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary R Mruz, DC

  • Chiropractor
  • Ocean View, NJ
  • NPI 1649218413
  Medicare reassignment Care Compare group NPD Authorized official
• William Joseph Mack III, DC

  • Chiropractor
  • Ocean View, NJ
  • NPI 1932918992
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289952000000",
    "number": "1003118456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 ROUTE 9",
            "address_2": "SUITE 101",
            "city": "PALERMO",
            "state": "NJ",
            "postal_code": "08230",
            "telephone_number": "609-390-8772",
            "fax_number": "609-390-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 ROUTE 9",
            "address_2": "SUITE 101",
            "city": "PALERMO",
            "state": "NJ",
            "postal_code": "08230",
            "telephone_number": "609-390-8772",
            "fax_number": "609-390-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-17",
        "last_updated": "2010-11-17",
        "status": "A",
        "authorized_official_last_name": "MRUZ",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER CHIROPRACTOR",
        "authorized_official_telephone_number": "609-390-8772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "MC03565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.