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General NPI Number Information
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NPI Number | 1033912746
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Entity Type | Organization
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Legal Business Name | LIGHTWAVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1415 MARLTON PIKE E STE 401
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2210
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Country | US
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Telephone | 856-375-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 MARLTON PIKE E STE 401
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2210
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Country | US
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Telephone | 856-904-6683
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Fax |
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Authorized Official
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Title or Position | OWNER AND CHIROPRACTOR
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Name | DR. NICHOLAS JOSEPH MANGANO JR.
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Credential | DC
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Telephone | 856-904-6683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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