Provider Demographics
NPI:1700042108
Name:WELLNESS RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:WELLNESS RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-691-6055
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-0487
Mailing Address - Country:US
Mailing Address - Phone:856-691-6055
Mailing Address - Fax:856-691-0496
Practice Address - Street 1:1317 S MAIN RD
Practice Address - Street 2:UNIT#2C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6511
Practice Address - Country:US
Practice Address - Phone:856-691-6055
Practice Address - Fax:856-691-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty