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General NPI Number Information
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NPI Number | 1902234560
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Entity Type | Organization
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Legal Business Name | BACK TO WELLNESS CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 525 MILLTOWN RD SUITE 201
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902
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Country | US
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Telephone | 732-545-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 525 MILLTOWN RD STE 201
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-3317
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Country | US
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Telephone | 732-545-3300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUCIEN JOSEPH EID
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Credential | DC
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Telephone | 732-545-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01722700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00559100
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License Number State | NJ
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