Provider Demographics
NPI:1255928321
Name:JERSEY CITY WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:JERSEY CITY WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-948-8788
Mailing Address - Street 1:520 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2507
Mailing Address - Country:US
Mailing Address - Phone:201-706-2244
Mailing Address - Fax:201-706-2376
Practice Address - Street 1:520 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2507
Practice Address - Country:US
Practice Address - Phone:201-706-2244
Practice Address - Fax:201-706-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty