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General NPI Number Information
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NPI Number | 1811296353
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Entity Type | Organization
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Legal Business Name | SOMERSET HILLS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 139 MORRISTOWN RD
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2633
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Country | US
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Telephone | 908-221-0808
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Fax | 908-221-9024
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Provider Business Mailing Address
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Address Line | 139 MORRISTOWN RD
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-2633
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Country | US
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Telephone | 908-221-0808
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Fax | 908-221-9024
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM R WALLACE
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Credential |
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Telephone | 908-221-0808
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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 | 1922
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License Number State | NJ
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