Decotiis Chiropractic Wellness, LLC
Organization Active NPI Chiropractor · Pitman, NJ
NPI 1700107778 · NPPES record last updated Jun 14, 2010
Key facts
- NPI
- 1700107778
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 38MC00636000 (NJ)
- Legal business name
- DECOTIIS CHIROPRACTIC WELLNESS, LLC
- Practice address
- 30 W Holly Ave
Pitman, NJ 08071-1405 - Phone
- (856) 218-1330
- Fax
- (856) 218-1332
- NPI assigned
- Jun 14, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. John R De Cotiis, D.C.
- Title
- Ceo/ Owner
- Phone
- (856) 218-1330
Practitioners 1
-
John R De Cotiis, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100616000691 | NJ | Part B Supplier - Clinic/Group Practice | 8224168315 |
Receives reassigned benefits from 1 practitioner Practice locations: Pitman, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 38MC00636000 | NJ | Yes |
Addresses
Primary practice location
30 W Holly Ave
Pitman, NJ 08071-1405
Mailing address
30 W Holly Ave
Pitman, NJ 08071-1405
Phone (856) 218-1330
Other providers in Pitman, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.