Provider Demographics
NPI:1326233859
Name:CHIROPRACTIC WELLNESS CENTER OF CLIFTON, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER OF CLIFTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAGWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-773-8244
Mailing Address - Street 1:1425 BROAD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4201
Mailing Address - Country:US
Mailing Address - Phone:973-773-8244
Mailing Address - Fax:973-591-0474
Practice Address - Street 1:1425 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4201
Practice Address - Country:US
Practice Address - Phone:973-773-8244
Practice Address - Fax:973-591-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00583300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00408818OtherRAILROAD MEDICARE
NJP00408818OtherRAILROAD MEDICARE