Healthcare Provider Details

I. General information

NPI: 1891064846
Provider Name (Legal Business Name): ADVANCED HEALING & PAIN RELIEF CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 MORRIS AVE STE 101
UNION NJ
07083-5708
US

IV. Provider business mailing address

2414 MORRIS AVE STE 101
UNION NJ
07083-5708
US

V. Phone/Fax

Practice location:
  • Phone: 908-349-0342
  • Fax:
Mailing address:
  • Phone: 908-349-0342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number38MC00689200
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL P WILLEMSE
Title or Position: OWNER
Credential: D.C.
Phone: 908-349-0342