Provider Demographics
NPI:1164761474
Name:AMERICAN CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:AMERICAN CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:RIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-840-8422
Mailing Address - Street 1:11 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3562
Mailing Address - Country:US
Mailing Address - Phone:732-840-8422
Mailing Address - Fax:732-840-8442
Practice Address - Street 1:11 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3562
Practice Address - Country:US
Practice Address - Phone:732-840-8422
Practice Address - Fax:732-840-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00502700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ904264Medicare PIN