Healthcare Provider Details

I. General information

NPI: 1457686552
Provider Name (Legal Business Name): HOBOKEN CHIROPRACTIC AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HARRISON ST SUITE 316
HOBOKEN NJ
07030-6064
US

IV. Provider business mailing address

50 HARRISON ST SUITE 316
HOBOKEN NJ
07030-6064
US

V. Phone/Fax

Practice location:
  • Phone: 201-792-3544
  • Fax: 201-792-3343
Mailing address:
  • Phone: 201-792-3544
  • Fax: 201-792-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number38MC00614700
License Number StateNJ

VIII. Authorized Official

Name: DR. LAURA T BRAYTON
Title or Position: OWNER
Credential: D.C.
Phone: 201-792-3544