MEDICARE: MR. ANTHONY DEEUGENIO III 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	DC009628	PA

General Provider Information

NPI Number	:	1184822165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY DEEUGENIO III D.C.

Provider Business Mailing Address
First Line	:	170 LANGLEY RD
Second Line	:
City	:	PITTSGROVE
State	:	NJ
Zip	:	08318-2032
Country	:	US
Telephone Number	:	856-305-2145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2300
Country	:	US
Telephone Number	:	215-551-3720
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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