Back & Spine Center of Passaic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00550700 Issued in NJ

Legal business name

BACK & SPINE CENTER OF PASSAIC, LLC

Practice address

647 Main Ave
Suite 202
Passaic, NJ 07055-4934

Phone

(973) 473-7200

Fax

(973) 473-7202

NPI assigned

Jan 18, 2016

Last updated

Feb 15, 2016By 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. Renato M. Cappello, DC

Title

Owner

Phone

(973) 473-7200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1265899538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 MAIN AVE",
            "address_2": "SUITE 202",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554934",
            "telephone_number": "973-473-7200",
            "fax_number": "973-473-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 MAIN AVE",
            "address_2": "SUITE 202",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070554934",
            "telephone_number": "973-473-7200",
            "fax_number": "973-473-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK & SPINE CENTER OF PASSAIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-18",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "CAPPELLO",
        "authorized_official_first_name": "RENATO",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-473-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00550700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.