=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588879555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL HEALTH CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2007
-----------------------------------------------------
Last Update Date | 01/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 566A UNION AVE
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807-3146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-231-8088
-----------------------------------------------------
Fax | 908-722-8722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 154 ADAMSVILLE RD
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-231-8088
-----------------------------------------------------
Fax | 908-722-8722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR & OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | DR. TERRESA DIANE BALESTRACCI
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 610-391-8884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0038MC00447100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------