Healthcare Provider Details

I. General information

NPI: 1164016762
Provider Name (Legal Business Name): GRATEFULHEALER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 RTE 34 STE 27
ABERDEEN NJ
07747-1903
US

IV. Provider business mailing address

9 SWEET BRIAR LN
HOLMDEL NJ
07733-2111
US

V. Phone/Fax

Practice location:
  • Phone: 615-410-8307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINA PISANELLO
Title or Position: OWNER/PROVIDER
Credential:
Phone: 615-410-8307