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General NPI Number Information
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NPI Number | 1386315737
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Entity Type | Organization
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Legal Business Name | REVOLUTION SPINE AND REHAB
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 8 LARSEN CT
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-5720
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Country | US
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Telephone | 908-642-9953
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Fax |
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Provider Business Mailing Address
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Address Line | 8 LARSEN CT
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-5720
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Country | US
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Telephone | 908-642-9953
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WINSON MA
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Credential | DC
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Telephone | 908-458-6860
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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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