Provider Demographics
NPI:1861720930
Name:HOLIDAY CITY CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:HOLIDAY CITY CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-552-9693
Mailing Address - Street 1:318 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2070
Mailing Address - Country:US
Mailing Address - Phone:732-552-9693
Mailing Address - Fax:
Practice Address - Street 1:318 MAINE ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2070
Practice Address - Country:US
Practice Address - Phone:732-552-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00604500261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center