Joseph Licitra DC LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

JOSEPH LICITRA DC LLC

Practice address

300 Broadacres Dr Ste 126a
Bloomfield, NJ 07003-3153

Phone

(973) 470-0632

Fax

(973) 893-8259

NPI assigned

Sep 30, 2022

Organization subpart

No

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

Authorized official

Name

Joseph Licitra, DCNPI 1891795514

Title

Owner

Phone

(201) 247-5363

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.

• Joseph J Licitra, DC

  • Chiropractor
  • Bloomfield, NJ
  • NPI 1891795514
  Medicare reassignment NPD Authorized official
• Neal Shah, DPT

  • Physical Therapist
  • Morris Plains, NJ
  • NPI 1104248350
  Medicare reassignment NPD

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

{
    "created_epoch": "1664496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664496000000",
    "number": "1902520109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 BROADACRES DR STE 126A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033153",
            "telephone_number": "973-470-0632",
            "fax_number": "973-893-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BROADACRES DR STE 126A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033153",
            "telephone_number": "973-470-0632",
            "fax_number": "973-893-8259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH LICITRA DC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-30",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A",
        "authorized_official_last_name": "LICITRA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-247-5363",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jones Inspirations Counseling
• Suja K Jose, PT
• Deborah Josefson, MD
• Joseph Distefano, DMD, PC
• Joseph Gardiner, DPM
• Cantave Joseph
• Joanne Iris Joseph, MS ED
• Miriam Joseph
• Jubilee Care LLC
• Judith Samara Post D.M.D.,LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; 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.