Healthcare Provider Details

I. General information

NPI: 1285040964
Provider Name (Legal Business Name): ABSOLUTE CHIROPRACTIC & MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MAIN ST
WOODBRIDGE NJ
07095-1958
US

IV. Provider business mailing address

245 MAIN ST
WOODBRIDGE NJ
07095-1958
US

V. Phone/Fax

Practice location:
  • Phone: 732-874-5109
  • Fax: 732-874-5134
Mailing address:
  • Phone: 732-874-5109
  • Fax: 732-874-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00608100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH MAZZEO III
Title or Position: OWNER
Credential: D.C.
Phone: 732-874-5109