Healthcare Provider Details

I. General information

NPI: 1336011477
Provider Name (Legal Business Name): CHAMPION WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STE 2 95 MCKEE DRIVE
MAHWAH NJ
07430
US

IV. Provider business mailing address

PO BOX 11
MAHWAH NJ
07430-0011
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 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: RICHARD ROSEN
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 201-642-4200