MEDICARE: SOMERVILLE CHIROPRACTIC CENTER PA

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	01470	NJ

General Provider Information

NPI Number	:	1033307301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMERVILLE CHIROPRACTIC CENTER PA

Provider Business Mailing Address
First Line	:	PO BOX 232
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-0232
Country	:	US
Telephone Number	:	732-560-1979
Fax Number	:	732-356-6333

Provider Business Practice Location Address
First Line	:	1910 WASHINGTON VALLEY RD
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2026
Country	:	US
Telephone Number	:	732-560-1979
Fax Number	:	732-356-6333

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH W THORN
Credential	:	D.C
Telephone Number	:	732-560-1979

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	06/13/2008

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