Provider Demographics
NPI:1255514741
Name:BASILE CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:BASILE CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-402-0110
Mailing Address - Street 1:3699 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1049
Mailing Address - Country:US
Mailing Address - Phone:973-402-0110
Mailing Address - Fax:973-402-1153
Practice Address - Street 1:3699 ROUTE 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1049
Practice Address - Country:US
Practice Address - Phone:973-402-0110
Practice Address - Fax:973-402-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC006044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
100713Medicare PIN