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General NPI Number Information
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NPI Number | 1154756591
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Entity Type | Organization
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Legal Business Name | MAPLE HEALTH & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 602 W MAPLE AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-1820
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Country | US
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Telephone | 856-486-4866
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Fax | 856-486-0952
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Provider Business Mailing Address
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Address Line | 602 W MAPLE AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-1820
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Country | US
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Telephone | 856-486-4866
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Fax | 856-486-0952
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS ERIKA PACHECO
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Credential |
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Telephone | 856-486-4866
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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 | 38MC00480100
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License Number State | NJ
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