MEDICARE: SPRINGFIELD HOLISTIC WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00528200	NJ

General Provider Information

NPI Number	:	1942676325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGFIELD HOLISTIC WELLNESS

Provider Business Mailing Address
First Line	:	719 MOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3221
Country	:	US
Telephone Number	:	973-379-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 MOUNTAIN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3221
Country	:	US
Telephone Number	:	973-379-2250
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN GARY BACALL
Credential	:	DC
Telephone Number	:	973-379-2250

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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