Provider Demographics
NPI:1538506654
Name:WAVES OF TRANSFORMATION WELLNESS CENTER INC
Entity Type:Organization
Organization Name:WAVES OF TRANSFORMATION WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-244-5008
Mailing Address - Street 1:309 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7409
Mailing Address - Country:US
Mailing Address - Phone:732-244-5008
Mailing Address - Fax:
Practice Address - Street 1:309 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7409
Practice Address - Country:US
Practice Address - Phone:732-244-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00303800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ536565Medicare UPIN