MEDICARE: DR. JACK MARTIN BARNATHAN D.C.

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	X004125	NY

General Provider Information

NPI Number	:	1063617595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MARTIN BARNATHAN D.C.

Provider Business Mailing Address
First Line	:	535 BROADHOLLOW RD
Second Line	:	SUITE A-16
City	:	MELVILLE
State	:	NY
Zip	:	11747-3719
Country	:	US
Telephone Number	:	631-777-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 BROADHOLLOW RD
Second Line	:	SUITE A-16
City	:	MELVILLE
State	:	NY
Zip	:	11747-3713
Country	:	US
Telephone Number	:	631-777-7800
Fax Number	:

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	07/08/2007

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