Provider Demographics
NPI:1477650745
Name:WELLSPRING HEALTH CENTER LLC
Entity Type:Organization
Organization Name:WELLSPRING HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-706-0280
Mailing Address - Street 1:2080 ROUTE 35
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1090
Mailing Address - Country:US
Mailing Address - Phone:732-706-0280
Mailing Address - Fax:732-706-0282
Practice Address - Street 1:2080 ROUTE 35
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1090
Practice Address - Country:US
Practice Address - Phone:732-706-0280
Practice Address - Fax:732-706-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJK0448688Medicare ID - Type Unspecified
NJT45073Medicare UPIN