Provider Demographics
NPI:1164991865
Name:DELCALZO SPINE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:DELCALZO SPINE AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DELCALZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-229-0700
Mailing Address - Street 1:5 HORIZON RD APT 1208
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6636
Mailing Address - Country:US
Mailing Address - Phone:201-229-0700
Mailing Address - Fax:
Practice Address - Street 1:75 NJ -17
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604
Practice Address - Country:US
Practice Address - Phone:201-229-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty