Healthcare Provider Details

I. General information

NPI: 1063833283
Provider Name (Legal Business Name): COLACURCIO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BLOOMFIELD AVE
CALDWELL NJ
07006-5311
US

IV. Provider business mailing address

85 BLOOMFIELD AVE
CALDWELL NJ
07006-5311
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-2481
  • Fax: 973-228-5091
Mailing address:
  • Phone: 973-228-2481
  • Fax: 973-228-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00668500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01411800
License Number StateNJ

VIII. Authorized Official

Name: STEVE VINCENT COLACURCIO
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 973-228-2481