Healthcare Provider Details

I. General information

NPI: 1295157956
Provider Name (Legal Business Name): NATURAL HEALTHCARE CENTER OF MIDDLETOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LEONARDVILLE RD
MIDDLETOWN NJ
07748-2360
US

IV. Provider business mailing address

9 LEONARDVILLE RD
MIDDLETOWN NJ
07748-2360
US

V. Phone/Fax

Practice location:
  • Phone: 732-671-9005
  • Fax:
Mailing address:
  • Phone: 732-671-9005
  • 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

VIII. Authorized Official

Name: MARC DESIDERIO
Title or Position: OWNER
Credential: D.C.
Phone: 732-671-9005