Provider Demographics
NPI:1598255002
Name:CHAMPION HEALTH SH LLC
Entity Type:Organization
Organization Name:CHAMPION HEALTH SH LLC
Other - Org Name:CHAMPION HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:
Authorized Official - First Name:CHAMPION
Authorized Official - Middle Name:
Authorized Official - Last Name:HW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-642-4200
Mailing Address - Street 1:PO BOX 10940
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-6940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6215
Practice Address - Country:US
Practice Address - Phone:201-642-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty