MEDICARE: AXIOMWELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	2251X0800X	Orthopedic Physical Therapist
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1003263005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIOMWELLNESS LLC

Provider Business Mailing Address
First Line	:	2357 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6229
Country	:	US
Telephone Number	:	201-944-4552
Fax Number	:	201-944-6551

Provider Business Practice Location Address
First Line	:	2357 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6229
Country	:	US
Telephone Number	:	201-944-4552
Fax Number	:	201-944-6551

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JOHN KIM
Credential	:	DC
Telephone Number	:	201-944-4552

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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Directions to “AXIOMWELLNESS LLC ” Practice Location

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