Provider Demographics
NPI:1902234560
Name:BACK TO WELLNESS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BACK TO WELLNESS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-545-3300
Mailing Address - Street 1:525 MILLTOWN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3317
Mailing Address - Country:US
Mailing Address - Phone:732-545-3300
Mailing Address - Fax:
Practice Address - Street 1:525 MILLTOWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-545-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00559100111N00000X
171100000X
NJ40QA01722700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty