Provider Demographics
NPI:1619082229
Name:DIZON WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:DIZON WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELINO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-835-3400
Mailing Address - Street 1:1069 RINGWOOD AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1408
Mailing Address - Country:US
Mailing Address - Phone:973-835-3400
Mailing Address - Fax:973-835-3411
Practice Address - Street 1:1069 RINGWOOD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1408
Practice Address - Country:US
Practice Address - Phone:973-835-3400
Practice Address - Fax:973-835-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00553400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty