Provider Demographics
NPI:1861632663
Name:JERSEY SHORE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:JERSEY SHORE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GARROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-223-1990
Mailing Address - Street 1:2204 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2323
Mailing Address - Country:US
Mailing Address - Phone:732-223-1990
Mailing Address - Fax:732-223-2750
Practice Address - Street 1:2204 HWY. 35
Practice Address - Street 2:#7
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750
Practice Address - Country:US
Practice Address - Phone:732-223-1990
Practice Address - Fax:732-223-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ05570111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty