Provider Demographics
NPI:1023403722
Name:NEW JERSEY SPINE AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:NEW JERSEY SPINE AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAROFILIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-747-6346
Mailing Address - Street 1:61 LAKE TRL E
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4447
Mailing Address - Country:US
Mailing Address - Phone:908-770-1325
Mailing Address - Fax:
Practice Address - Street 1:502 HAMBURG TPKE STE 203A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8446
Practice Address - Country:US
Practice Address - Phone:973-747-6346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty