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General NPI Number Information
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NPI Number | 1013106756
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Entity Type | Organization
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Legal Business Name | COMPLETE CHIROPRACTIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 354 OLD HOOK RD 101
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City | WESTWOOD
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State | NJ
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Zip | 07675-3246
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Country | US
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Telephone | 201-664-8587
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Fax | 201-722-0882
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Provider Business Mailing Address
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Address Line | 354 OLD HOOK RD 101
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City | WESTWOOD
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State | NJ
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Zip | 07675-3246
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Country | US
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Telephone | 201-664-8587
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Fax | 201-722-0882
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. DARREN PORCARO
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Credential | D.C.
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Telephone | 201-664-8587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00574900
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License Number State | NJ
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