Healthcare Provider Details

I. General information

NPI: 1487974978
Provider Name (Legal Business Name): GULOTTA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 MAIN ST UNIT 101
LAKE COMO NJ
07719-3096
US

IV. Provider business mailing address

1717 MAIN ST UNIT 101
LAKE COMO NJ
07719-3096
US

V. Phone/Fax

Practice location:
  • Phone: 732-681-2200
  • Fax: 732-681-5954
Mailing address:
  • Phone: 732-681-2200
  • Fax: 732-681-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00617800
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH GULOTTA
Title or Position: OWNER
Credential: DC
Phone: 732-681-2200