1184784449 NPI number — SANTANGELO CHIROPRACTIC AND REHABILITATION CENTER, LLC

Table of content: (NPI 1184784449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184784449 NPI number — SANTANGELO CHIROPRACTIC AND REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTANGELO CHIROPRACTIC AND REHABILITATION CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTEGRATIVE WELLNESS ASSOCIATES, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184784449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HEATHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HANOVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07936-3203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-428-8244
Provider Business Mailing Address Fax Number:
973-428-8123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HEATHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST HANOVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07936-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-428-8244
Provider Business Practice Location Address Fax Number:
973-428-8123
Provider Enumeration Date:
12/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTANGELO
Authorized Official First Name:
FREDRICK
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
DIRECTOR/MANAGING MEMBER
Authorized Official Telephone Number:
973-428-8244

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00181400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: 38MC00181400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X , with the licence number: 38MC00181400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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