Healthcare Provider Details

I. General information

NPI: 1265707939
Provider Name (Legal Business Name): PROSPERITY HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 HIGHWAY 34 SUITE 207
MATAWAN NJ
07747-3258
US

IV. Provider business mailing address

952 HIGHWAY 34 SUITE 207
MATAWAN NJ
07747-3258
US

V. Phone/Fax

Practice location:
  • Phone: 732-696-8282
  • Fax:
Mailing address:
  • Phone: 732-696-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. JENG KUAN
Title or Position: OWNER
Credential: DC
Phone: 732-696-8282