Provider Demographics
NPI:1457686552
Name:HOBOKEN CHIROPRACTIC AND WELLNESS INC
Entity Type:Organization
Organization Name:HOBOKEN CHIROPRACTIC AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-792-3544
Mailing Address - Street 1:50 HARRISON ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6064
Mailing Address - Country:US
Mailing Address - Phone:201-792-3544
Mailing Address - Fax:201-792-3343
Practice Address - Street 1:50 HARRISON ST
Practice Address - Street 2:SUITE 316
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6064
Practice Address - Country:US
Practice Address - Phone:201-792-3544
Practice Address - Fax:201-792-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00614700261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071586Medicare PIN