Healthcare Provider Details

I. General information

NPI: 1558690321
Provider Name (Legal Business Name): INTEGRATED WELLNESS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 08/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WHITEHORSE-MERCERVILLE RD SUITE 409
HAMILTON NJ
08619
US

IV. Provider business mailing address

1245 WHITEHORSE-MERCERVILLE RD SUITE 409
HAMILTON NJ
08619
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-6100
  • Fax: 609-581-2103
Mailing address:
  • Phone: 609-585-6100
  • Fax: 609-581-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY QUILLE
Title or Position: DOCTOR
Credential: DC
Phone: 609-585-6100