Provider Demographics
NPI:1902970155
Name:THE WELLNESS INSTITUTE PC
Entity Type:Organization
Organization Name:THE WELLNESS INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ACANFORA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-858-0444
Mailing Address - Street 1:120 LEFANTE WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5060
Mailing Address - Country:US
Mailing Address - Phone:201-858-4444
Mailing Address - Fax:
Practice Address - Street 1:120 LEFANTE WAY STE 1
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5060
Practice Address - Country:US
Practice Address - Phone:201-858-4444
Practice Address - Fax:201-858-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00502900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083603Medicare PIN