Healthcare Provider Details

I. General information

NPI: 1902234560
Provider Name (Legal Business Name): BACK TO WELLNESS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MILLTOWN RD SUITE 201
NORTH BRUNSWICK NJ
08902
US

IV. Provider business mailing address

525 MILLTOWN RD STE 201
NORTH BRUNSWICK NJ
08902-3317
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-3300
  • Fax:
Mailing address:
  • Phone: 732-545-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01722700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00559100
License Number StateNJ

VIII. Authorized Official

Name: LUCIEN JOSEPH EID
Title or Position: OWNER
Credential: DC
Phone: 732-545-3300