Provider Demographics
NPI:1952463267
Name:BRICK PAIN RELIEF AND WELLNESS, INST.
Entity Type:Organization
Organization Name:BRICK PAIN RELIEF AND WELLNESS, INST.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-899-5400
Mailing Address - Street 1:2095 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3265
Mailing Address - Country:US
Mailing Address - Phone:732-899-5400
Mailing Address - Fax:732-899-9288
Practice Address - Street 1:2095 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3265
Practice Address - Country:US
Practice Address - Phone:732-899-5400
Practice Address - Fax:732-899-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC2602111N00000X
NJMB53521208D00000X
NJQA01049100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6049930001OtherMEDICARE DME#