Provider Demographics
NPI:1063833283
Name:COLACURCIO WELLNESS LLC
Entity type:Organization
Organization Name:COLACURCIO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:COLACURCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-228-2481
Mailing Address - Street 1:85 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5311
Mailing Address - Country:US
Mailing Address - Phone:973-228-2481
Mailing Address - Fax:973-228-5091
Practice Address - Street 1:85 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5311
Practice Address - Country:US
Practice Address - Phone:973-228-2481
Practice Address - Fax:973-228-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01411800225100000X
NJ38MC00668500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty