Provider Demographics
NPI:1588879555
Name:TOTAL HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR & OFFICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRESA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BALESTRACCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-391-8884
Mailing Address - Street 1:154 ADAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3028
Mailing Address - Country:US
Mailing Address - Phone:908-231-8088
Mailing Address - Fax:908-722-8722
Practice Address - Street 1:566A UNION AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3146
Practice Address - Country:US
Practice Address - Phone:908-231-8088
Practice Address - Fax:908-722-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0038MC00447100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherBCBS PPO & TRADITIONAL