Provider Demographics
NPI:1033420559
Name:ATLANTIC WELLNESS GROUP
Entity Type:Organization
Organization Name:ATLANTIC WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:EASTBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-370-7880
Mailing Address - Street 1:2119 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2600
Mailing Address - Country:US
Mailing Address - Phone:732-370-7880
Mailing Address - Fax:732-370-2040
Practice Address - Street 1:2119 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-2600
Practice Address - Country:US
Practice Address - Phone:732-370-7880
Practice Address - Fax:732-370-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00587700111N00000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty