Healthcare Provider Details

I. General information

NPI: 1982776233
Provider Name (Legal Business Name): JERSEY A WULSTER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ORCHARD ST STE 103
DENVILLE NJ
07834-2160
US

IV. Provider business mailing address

25 ORCHARD ST STE 103
DENVILLE NJ
07834-2160
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-7800
  • Fax: 973-627-6982
Mailing address:
  • Phone: 973-625-7800
  • Fax: 973-627-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00260800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: