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General NPI Number Information
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NPI Number | 1619300530
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Entity Type | Organization
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Legal Business Name | DE JESUS WELLNESS GROUP, P.C
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 298 ROCK GLEN RD
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City | SUGARLOAF
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State | PA
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Zip | 18249-3211
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Country | US
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Telephone | 570-708-2228
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Fax | 570-708-2039
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Provider Business Mailing Address
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Address Line | 298 ROCK GLEN RD
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City | SUGARLOAF
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State | PA
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Zip | 18249-3211
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Country | US
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Telephone | 570-708-2228
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Fax | 570-708-2039
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROWENA M. DE JESUS
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Credential | D.C.
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Telephone | 570-708-2228
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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 | DC004270L
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License Number State | PA
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