Provider Demographics
NPI:1386905826
Name:QUANTUM WELLNESS AND REHABILITATION PC
Entity type:Organization
Organization Name:QUANTUM WELLNESS AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL BILLER
Authorized Official - Phone:601-878-6945
Mailing Address - Street 1:230 W JERSEY ST
Mailing Address - Street 2:STE. 303
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1364
Mailing Address - Country:US
Mailing Address - Phone:908-289-8556
Mailing Address - Fax:
Practice Address - Street 1:230 W JERSEY ST
Practice Address - Street 2:STE. 303
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1364
Practice Address - Country:US
Practice Address - Phone:908-289-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00504900111N00000X
NJ25MZ00020100111N00000X
NJMC04730111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty