MEDICARE: DR. MICHAEL JOHN SHUSTYK 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	38MC00359300	NJ

General Provider Information

NPI Number	:	1134285216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN SHUSTYK D.C.

Provider Business Mailing Address
First Line	:	168 BOULEVARD
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1826
Country	:	US
Telephone Number	:	201-288-1222
Fax Number	:	201-288-4876

Provider Business Practice Location Address
First Line	:	168 BOULEVARD
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1826
Country	:	US
Telephone Number	:	201-288-1222
Fax Number	:	201-288-4876

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

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	09/21/2007

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