Provider Demographics
NPI:1083256721
Name:JOURNAL SQ SPINE & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:JOURNAL SQ SPINE & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-763-7521
Mailing Address - Street 1:35 JOURNAL SQ STE 502
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4007
Mailing Address - Country:US
Mailing Address - Phone:201-763-7521
Mailing Address - Fax:201-763-7393
Practice Address - Street 1:35 JOURNAL SQ STE 502
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4007
Practice Address - Country:US
Practice Address - Phone:201-763-7521
Practice Address - Fax:201-763-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty