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General NPI Number Information
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NPI Number | 1154022721
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Entity Type | Organization
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Legal Business Name | SO CHIROPRACTIC WELLNESS PLLC
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 721 N BEERS ST STE 1E
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City | HOLMDEL
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State | NJ
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Zip | 07733-1500
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Country | US
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Telephone | 732-858-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 721 N BEERS ST STE 1E
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City | HOLMDEL
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State | NJ
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Zip | 07733-1500
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Country | US
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Telephone | 732-391-7548
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN SO
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Credential | DC
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Telephone | 732-391-7548
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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 |
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License Number State |
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