Provider Demographics
NPI:1013106756
Name:COMPLETE CHIROPRACTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORCARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-664-8587
Mailing Address - Street 1:354 OLD HOOK RD
Mailing Address - Street 2:101
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3246
Mailing Address - Country:US
Mailing Address - Phone:201-664-8587
Mailing Address - Fax:201-722-0882
Practice Address - Street 1:354 OLD HOOK RD
Practice Address - Street 2:101
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3246
Practice Address - Country:US
Practice Address - Phone:201-664-8587
Practice Address - Fax:201-722-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00574900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096165Medicare PIN