Healthcare Provider Details

I. General information

NPI: 1952605792
Provider Name (Legal Business Name): BELLEVILLE ACCIDENT AND INJURY RELIEF CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 WASHINGTON AVE
BELLEVILLE NJ
07109-3334
US

IV. Provider business mailing address

544 WASHINGTON AVE
BELLEVILLE NJ
07109-3334
US

V. Phone/Fax

Practice location:
  • Phone: 973-759-3020
  • Fax:
Mailing address:
  • Phone: 973-759-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC05321
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01281000
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL CHILLEMI
Title or Position: CEO
Credential: DC
Phone: 973-759-3020