Provider Demographics
NPI:1073661070
Name:ATLANTIC WELLNESS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ATLANTIC WELLNESS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-880-7077
Mailing Address - Street 1:2509 PARK AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5300
Mailing Address - Country:US
Mailing Address - Phone:908-755-0590
Mailing Address - Fax:908-755-0600
Practice Address - Street 1:380 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5716
Practice Address - Country:US
Practice Address - Phone:201-880-7077
Practice Address - Fax:201-880-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01095700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081352Medicare ID - Type Unspecified