Healthcare Provider Details

I. General information

NPI: 1215327408
Provider Name (Legal Business Name): NJ CHIROPRACTIC AND PHYSICAL THERAPY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 JOHN F KENNEDY BLVD STE 316
JERSEY CITY NJ
07306-3817
US

IV. Provider business mailing address

3000 JOHN F KENNEDY BLVD STE 316
JERSEY CITY NJ
07306-3817
US

V. Phone/Fax

Practice location:
  • Phone: 201-963-0200
  • Fax: 201-222-1364
Mailing address:
  • Phone: 201-963-0200
  • Fax: 201-222-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUMMEL G. MENDOZA
Title or Position: OWNER
Credential: DC
Phone: 201-963-0200