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General NPI Number Information
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NPI Number | 1952337529
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE WELLNESS, LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1139 SPRUCE DR SECOND FLOOR
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2221
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Country | US
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Telephone | 908-233-3993
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Fax |
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Provider Business Mailing Address
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Address Line | 512 ELIAS AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2208
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Country | US
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Telephone | 732-236-4701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN M TOTIN
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Credential | DC
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Telephone | 732-236-4701
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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 | 38MC00617100
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License Number State | NJ
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