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General NPI Number Information
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NPI Number | 1538497151
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Entity Type | Organization
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Legal Business Name | PST WELLNESS CENTER
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 871 ALLWOOD ROAD
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City | CLIFTON
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State | NJ
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Zip | 07012
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Country | US
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Telephone | 973-865-9565
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Fax | 973-365-8004
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Provider Business Mailing Address
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Address Line | 871 ALLWOOD ROAD
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City | CLIFTON
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State | NJ
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Zip | 07012
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Country | US
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Telephone | 973-865-9565
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Fax | 973-365-8004
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. PETER STEFAN TATARENKO
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Credential | D.C.
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Telephone | 973-865-9565
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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 | 38MC00677900
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License Number State | NJ
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