MEDICARE: DR. AMY P MERCOVICH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X008349	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5752802	OTHER	NY	AETNA
2	P010008349	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1013947837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY P MERCOVICH DC

Provider Business Mailing Address
First Line	:	PO BOX 606
Second Line	:
City	:	BERGEN
State	:	NY
Zip	:	14416
Country	:	US
Telephone Number	:	585-494-2870
Fax Number	:	585-494-2260

Provider Business Practice Location Address
First Line	:	45 N LAKE ST
Second Line	:
City	:	BERGEN
State	:	NY
Zip	:	14416
Country	:	US
Telephone Number	:	585-494-2870
Fax Number	:	585-494-2260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/07/2010

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