Healthcare Provider Details

I. General information

NPI: 1649545625
Provider Name (Legal Business Name): STILLWATER HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 STILLWATER RD
BLAIRSTOWN NJ
07825-9561
US

IV. Provider business mailing address

18 STILLWATER RD
BLAIRSTOWN NJ
07825-9561
US

V. Phone/Fax

Practice location:
  • Phone: 908-362-8767
  • Fax: 908-362-8770
Mailing address:
  • Phone: 908-362-8767
  • Fax: 908-362-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00455900
License Number StateNJ

VIII. Authorized Official

Name: DR. SANDY GIACOBBE JR.
Title or Position: OWNER
Credential: D.C.
Phone: 908-362-8767