Healthcare Provider Details

I. General information

NPI: 1821283490
Provider Name (Legal Business Name): HAVERON TOTAL HEALTH, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ELIZABETH AVE
ELIZABETH NJ
07201-2710
US

IV. Provider business mailing address

909 ELIZABETH AVE
ELIZABETH NJ
07201-2710
US

V. Phone/Fax

Practice location:
  • Phone: 908-629-0779
  • Fax: 908-629-0804
Mailing address:
  • Phone: 908-629-0779
  • Fax: 908-629-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00344800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01050700
License Number StateNJ

VIII. Authorized Official

Name: DR. THOMAS M. HAVERON
Title or Position: OWNER
Credential: DC
Phone: 908-629-0779