Provider Demographics
NPI:1124315692
Name:CHIROPRACTIC WELLNESS & REHABILITATION P.C.
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS & REHABILITATION P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOLTANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-815-1159
Mailing Address - Street 1:1300 MAIN AVE. SUITE 2B.
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-928-6180
Mailing Address - Fax:973-928-6179
Practice Address - Street 1:1300 MAIN AVENUE
Practice Address - Street 2:SUITE 2B
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2266
Practice Address - Country:US
Practice Address - Phone:973-815-1159
Practice Address - Fax:973-815-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00404800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty