1629331129 NPI number — CHIROPRACTIC HEALTH AND WELLNESS CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629331129 NPI number — CHIROPRACTIC HEALTH AND WELLNESS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC HEALTH AND WELLNESS 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:
Provider Other Organization Name Type Code:
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:
1629331129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1398 HIGHWAY 35
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07712-3543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-531-0840
Provider Business Mailing Address Fax Number:
732-531-3330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1398 HIGHWAY 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07712-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-531-0840
Provider Business Practice Location Address Fax Number:
732-531-3330
Provider Enumeration Date:
06/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEE-BASS
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-531-0840

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00491700 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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