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General NPI Number Information
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NPI Number | 1356886493
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Entity Type | Organization
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Legal Business Name | HEALTHY SPINE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 1301 PRINCE RODGERS AVE
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2020
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Country | US
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Telephone | 908-370-6256
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 PRINCE RODGERS AVE
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2020
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Country | US
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Telephone | 908-370-6256
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MS. STACEY A. STEFANSKI
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Credential | DC
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Telephone | 908-370-6256
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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 | 38MC00582700
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License Number State | NJ
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