Healthcare Provider Details

I. General information

NPI: 1548691363
Provider Name (Legal Business Name): VAN BLARCOM CHIROPRACTIC AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 FRANKLIN TPKE
WALDWICK NJ
07463-1820
US

IV. Provider business mailing address

93 FRANKLIN TPKE
WALDWICK NJ
07463-1820
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-8091
  • Fax: 201-445-2950
Mailing address:
  • Phone: 201-445-8091
  • Fax: 201-445-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00699600
License Number StateNJ

VIII. Authorized Official

Name: DR. LEAH VAN BLARCOM
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 201-445-8091