=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952280653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVE FULLY NOW REHAB AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2025
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 COUNTY ROAD 517
-----------------------------------------------------
City | HACKETTSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07840-2730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-244-5885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 433
-----------------------------------------------------
City | HACKETTSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07840-0433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-244-5885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BLAKE SCHICKER
-----------------------------------------------------
Credential | LAC, COTA, MSOM
-----------------------------------------------------
Telephone | 862-244-5885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------