Provider Demographics
NPI:1821631409
Name:FLOURISH NUTRITION AND CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FLOURISH NUTRITION AND CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MAKIN
Authorized Official - Last Name:SANNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-284-7550
Mailing Address - Street 1:264 FAIR HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3417
Mailing Address - Country:US
Mailing Address - Phone:732-284-7550
Mailing Address - Fax:732-933-4125
Practice Address - Street 1:55 STATE ROUTE 35 STE 1
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5918
Practice Address - Country:US
Practice Address - Phone:732-284-7550
Practice Address - Fax:732-933-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty