Healthcare Provider Details

I. General information

NPI: 1972858736
Provider Name (Legal Business Name): EBENEZER O-A BILEWU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 W JIMMIE LEEDS RD STE 301
GALLOWAY NJ
08205-9418
US

IV. Provider business mailing address

76 W JIMMIE LEEDS RD STE 301
GALLOWAY NJ
08205-9418
US

V. Phone/Fax

Practice location:
  • Phone: 609-573-5310
  • Fax: 606-573-5310
Mailing address:
  • Phone: 609-573-5310
  • Fax: 609-241-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00702600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00702600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number38MC00702600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00702600
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number38MC00702600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number38MC00702600
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number38MC00702600
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number38MC00702600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: