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General NPI Number Information
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NPI Number | 1053601666
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD CHIROPRACTIC & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 200 ENGLE ST SUITE 20
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2440
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Country | US
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Telephone | 201-569-7004
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Fax | 973-569-7101
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Provider Business Mailing Address
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Address Line | 200 ENGLE ST SUITE 20
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2440
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Country | US
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Telephone | 201-569-7004
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Fax | 973-569-7101
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIELLE ROTHMAN
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Credential | DC
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Telephone | 201-569-7004
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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 | 38MC00545500
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License Number State | NJ
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