Healthcare Provider Details

I. General information

NPI: 1417648700
Provider Name (Legal Business Name): GREEN HILL CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 OXMEAD RD
BURLINGTON NJ
08016-4215
US

IV. Provider business mailing address

1603 OXMEAD RD
BURLINGTON NJ
08016-4215
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL DETULLIO
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 609-386-6100