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General NPI Number Information
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NPI Number | 1649485343
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY HEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 1919 GREENTREE RD SUITE A
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City | CHERRY HILL
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State | NJ
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Zip | 08003-1115
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Country | US
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Telephone | 856-761-8100
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Fax | 856-761-8107
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Provider Business Mailing Address
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Address Line | 1919 GREENTREE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08003-1115
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Country | US
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Telephone | 856-761-8100
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Fax | 856-761-8107
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MICHAEL EDENZON
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Credential | D.C.
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Telephone | 856-761-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 38MC00534300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | DC-007149-L
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License Number State | PA
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