Individual provider Active NPI

Kevin Pecca Jr., D.C

  • Chiropractor
  • West Orange, NJ
National Provider Identifier
1356889133
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00742200 Issued in NJ
Practice address
155 Prospect Ave Ste 202
West Orange, NJ 07052-4204
Phone
(973) 744-3456
Fax
(973) 744-3456
NPI assigned
Feb 1, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 38MC00742200 NJ Primary

Addresses

Primary practice location

155 Prospect Ave Ste 202
West Orange, NJ 07052-4204

Mailing address

155 Prospect Ave Ste 202
West Orange, NJ 07052-4204
Phone (973) 744-3456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170306000011 NJ Practitioner - Chiropractic 3476837725 Reassigns benefits to 1 organization
I20231017002584 FL Practitioner - Chiropractic 3476837725 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Montclair Upper Cervical Chiropractic LLCGroup PAC ID 6002179652, 2 clinicians

Practice addresses (Care Compare)

155 Prospect Ave
Suite 202
West Orange, NJ 07052-4204
Phone (973) 744-3456

2225 A1A
Suite A1
St Augustine, FL 32080-6374
Phone (904) 481-8953

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
38MC00742200NJMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Montclair Upper Cervical Chiropractic LLC Chiropractor CurrentSince Oct 11, 2017 Accepting new patients
Spine of Life Upper Cervical Chiropractic Chiropractor CurrentSince Oct 6, 2023 Accepting new patients

Locations

2225 A1A S
Ste A1
St Augustine, FL 32080
Phone (732) 740-0007

155 Prospect Ave
Ste 202
West Orange, NJ 07052
Phone (973) 744-3456

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1356889133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 PROSPECT AVE STE 202",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524204",
            "telephone_number": "973-744-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 PROSPECT AVE STE 202",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524204",
            "telephone_number": "973-744-3456",
            "fax_number": "973-744-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECCA",
        "first_name": "KEVIN",
        "name_suffix": "Jr.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-01",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00742200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Orange, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.