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General NPI Number Information
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NPI Number | 1376117853
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Entity Type | Organization
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Legal Business Name | LIFESTYLE WELLNESS
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 290 MADISON AVE STE 3A
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City | MORRISTOWN
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State | NJ
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Zip | 07960-7401
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Country | US
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Telephone | 973-590-2448
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Fax | 973-590-2449
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Provider Business Mailing Address
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Address Line | 224 NORWICH CT
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City | MADISON
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State | NJ
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Zip | 07940-1134
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Country | US
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Telephone | 973-900-0238
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. CYNTHIA D'AMELIO
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Credential | DC
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Telephone | 973-900-0238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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