Healthcare Provider Details

I. General information

NPI: 1528306412
Provider Name (Legal Business Name): BLISS CHIROPRACTIC AND REHAB CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 HUDSON PARK
EDGEWATER NJ
07020
US

IV. Provider business mailing address

1506 HUDSON PARK
EDGEWATER NJ
07020
US

V. Phone/Fax

Practice location:
  • Phone: 703-581-9552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00684200
License Number StateNJ

VIII. Authorized Official

Name: HONGSOON LIM
Title or Position: OWNER
Credential: D.C
Phone: 703-581-9552