Healthcare Provider Details

I. General information

NPI: 1174868889
Provider Name (Legal Business Name): ELITE CHIROPRACTIC & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD STE #29
HAZLET NJ
07730-1663
US

IV. Provider business mailing address

1 BETHANY RD
HAZLET NJ
07730-1663
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: STACI ADDESSI
Title or Position: OWNER
Credential:
Phone: 732-739-3345