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General NPI Number Information
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NPI Number | 1093594954
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Entity Type | Organization
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Legal Business Name | PREMIER SPINE AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 1809 CORLIES AVENUE SUITE 3
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City | NEPTUNE
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State | NJ
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Zip | 07753
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Country | US
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Telephone | 732-618-3220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 481
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City | MORGANVILLE
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State | NJ
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Zip | 07751-0481
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT KHAMISH
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Credential | DC
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Telephone | 732-618-3220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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