Healthcare Provider Details

I. General information

NPI: 1154240901
Provider Name (Legal Business Name): PRIMAL INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 PROSPECT AVE
WEST ORANGE NJ
07052-4112
US

IV. Provider business mailing address

494 PROSPECT AVE
WEST ORANGE NJ
07052-4112
US

V. Phone/Fax

Practice location:
  • Phone: 973-736-9797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KENSY JEAN
Title or Position: MANAGING MEMBER
Credential: DC, MSACN
Phone: 973-393-1249