Provider Demographics
NPI:1295233443
Name:ADVANCED WELLNESS AND REHABILITATION LLC
Entity type:Organization
Organization Name:ADVANCED WELLNESS AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GURRERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-285-0642
Mailing Address - Street 1:908 OAK TREE AVE STE S
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5135
Mailing Address - Country:US
Mailing Address - Phone:908-285-0642
Mailing Address - Fax:
Practice Address - Street 1:908 OAK TREE AVE STE S
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5135
Practice Address - Country:US
Practice Address - Phone:908-285-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X, 171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty