Provider Demographics
NPI:1023105236
Name:ADVANCED CHIROPRACTIC AND WELLNESS CENTER
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORAYR
Authorized Official - Middle Name:
Authorized Official - Last Name:OZBALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-561-1777
Mailing Address - Street 1:904 OAK TREE AVE
Mailing Address - Street 2:SUITE 904
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5126
Mailing Address - Country:US
Mailing Address - Phone:908-561-1777
Mailing Address - Fax:908-561-9711
Practice Address - Street 1:904 OAK TREE AVE
Practice Address - Street 2:SUITE 904
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5126
Practice Address - Country:US
Practice Address - Phone:908-561-1777
Practice Address - Fax:908-561-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00422600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2381661OtherAETNA
NJP1885364OtherOXFORD
NJX8Z38OtherWELLCHOICE
NJ217333OtherUHC
NJ0066109Medicaid
NJ20820140000OtherAMERIHEALTH
NJP1885364OtherOXFORD