Healthcare Provider Details

I. General information

NPI: 1649440652
Provider Name (Legal Business Name): ELITE CHIROPRACTIC AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY ROAD SUITE 29
HAZLET NJ
07730
US

IV. Provider business mailing address

1 BETHANY ROAD SUITE 29
HAZLET NJ
07730
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-3345
  • Fax: 732-739-3376
Mailing address:
  • Phone: 732-739-3345
  • Fax: 732-739-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00604200
License Number StateNJ

VIII. Authorized Official

Name: DR. STACI JOY ADDESSI
Title or Position: OWNWE
Credential: D.C.
Phone: 732-739-3345