Healthcare Provider Details

I. General information

NPI: 1093238511
Provider Name (Legal Business Name): CHAMPION HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MCKEE DR
MAHWAH NJ
07430-2105
US

IV. Provider business mailing address

PO BOX 10940
FAIRFIELD NJ
07004-6940
US

V. Phone/Fax

Practice location:
  • Phone: 201-642-4200
  • Fax: 201-642-4200
Mailing address:
  • Phone: 201-642-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00712900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHAMPION HEALTH
Title or Position: OWNER
Credential: D.C.
Phone: 201-642-4200