Healthcare Provider Details

I. General information

NPI: 1548760804
Provider Name (Legal Business Name): LAWRENCE SPINE & WELLNESS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 LAWRENCE SQUARE BLVD SOUTH
LAWRENCEVILLE NJ
08648
US

IV. Provider business mailing address

558 LAWRENCE SQUARE BLVD SOUTH
LAWRENCEVILLE NJ
08648
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-6100
  • Fax:
Mailing address:
  • Phone: 609-585-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00445200
License Number StateNJ

VIII. Authorized Official

Name: DR. GREGORY QUILLE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 609-709-7625