Provider Demographics
NPI:1194148981
Name:CORE SPINE & WELLNESS LLC
Entity type:Organization
Organization Name:CORE SPINE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:732-253-5450
Mailing Address - Street 1:180 TICES LN
Mailing Address - Street 2:BLDG A SUITE 105
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1337
Mailing Address - Country:US
Mailing Address - Phone:732-253-5450
Mailing Address - Fax:732-253-5451
Practice Address - Street 1:180 TICES LN
Practice Address - Street 2:BLDG A SUITE 105
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1337
Practice Address - Country:US
Practice Address - Phone:732-253-5450
Practice Address - Fax:732-253-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ124640980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty