Provider Demographics
NPI:1316008030
Name:DR INSANAS WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:DR INSANAS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:INSANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-662-4848
Mailing Address - Street 1:2028 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2014
Mailing Address - Country:US
Mailing Address - Phone:856-662-9223
Mailing Address - Fax:
Practice Address - Street 1:2028 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2014
Practice Address - Country:US
Practice Address - Phone:856-662-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-08-03
Deactivation Date:2022-06-13
Deactivation Code:
Reactivation Date:2022-08-03
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00493400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
884960Medicare ID - Type Unspecified