=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598578890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUSION CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 242 DELSEA DR
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-9469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-692-4032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 SUGAR LOAF HL
-----------------------------------------------------
City | CLARKSBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08510-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-692-4032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDREW BELCASTRO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 908-692-4032
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------