Provider Demographics
NPI:1225701527
Name:MONMOUTH SPINE AND WELLNESS LLC
Entity Type:Organization
Organization Name:MONMOUTH SPINE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:GABRIELLA
Authorized Official - Last Name:DECARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-916-5217
Mailing Address - Street 1:335 STIRRUP DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:917-916-5217
Mailing Address - Fax:
Practice Address - Street 1:342 ROUTE 9 STE 1
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9603
Practice Address - Country:US
Practice Address - Phone:917-916-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty