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General NPI Number Information
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NPI Number | 1407272453
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Entity Type | Organization
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Legal Business Name | HEALTH FUSION WELLNESS LLC
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 55 SCHANCK RD SUITE A-4
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City | FREEHOLD
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State | NJ
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Zip | 07728-2964
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Country | US
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Telephone | 732-665-6334
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Fax | 732-683-2477
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Provider Business Mailing Address
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Address Line | 55 SCHANCK RD SUITE A-4
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City | FREEHOLD
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State | NJ
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Zip | 07728-2964
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Country | US
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Telephone | 732-665-6334
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Fax | 732-683-2477
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL WALTER DIMARCO II
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Credential | D.C.
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Telephone | 732-665-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01539300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00709900
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License Number State | NJ
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