Healthcare Provider Details

I. General information

NPI: 1215279302
Provider Name (Legal Business Name): MAMIO CHRISTA DETULLIO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 OXMEAD RD
BURLINGTON NJ
08016-4215
US

IV. Provider business mailing address

1509 OXMEAD RD
BURLINGTON NJ
08016-4211
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-6100
  • Fax:
Mailing address:
  • Phone: 672-806-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00706900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: