South Jersey Spine & Sport LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

SOUTH JERSEY SPINE & SPORT LLC

Doing business as

Sports Recovery Lab of Haddonfield

Practice address

56 N Haddon Ave Lowr Level
Haddonfield, NJ 08033-2438

Phone

(856) 240-7529

NPI assigned

Dec 22, 2021

Organization subpart

No

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

Authorized official

Name

Michael Distler, DC, CCSP

Title

Owner

Phone

(203) 241-4574

Specialties & licenses 1

Addresses

Other names 1

• Sports Recovery Lab of Haddonfield Doing business as

Locations

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

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1497415160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 N HADDON AVE LOWR LEVEL",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332438",
            "telephone_number": "856-240-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 N HADDON AVE LOWR LEVEL",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332438",
            "telephone_number": "856-240-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JERSEY SPINE & SPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "DISTLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-241-4574",
        "authorized_official_credential": "DC, CCSP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Recovery Lab of Haddonfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judith Smith, LCSW
• Rebecca Smith, OTR/L
• James B Soffer, DDS
• Janet Ruth Sokoloff, MSW, LCSW
• South Jersey Counseling Associates, Inc.
• South Jersey Sports Chiropractic LLC
• Sparrow'S Solace Therapy Services LLC
• Nathan Spencer, DDS
• Shelley Elizabeth Stahl I, MSW,LCSW
• Lisa Marie Stammerjohann, MA, LPC

• Chiropractor in Haddonfield, NJ
• Providers in Haddonfield, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.