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General NPI Number Information
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NPI Number | 1235341736
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Entity Type | Organization
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Legal Business Name | ADSWELLNESS LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18 TUTOR PLACE
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 908-420-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 18 TUTOR PLACE
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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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 | PRESIDENT
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Name | GLENN LEDERMAN
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Credential | DC
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Telephone | 908-420-8057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | MC 04697
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License Number State | NJ
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