MEDICARE: DR. MARIE JEAN DESTEFAN 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	NJMC03606	NJ

General Provider Information

NPI Number	:	1376632406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE JEAN DESTEFAN DC

Provider Business Mailing Address
First Line	:	314 48TH ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5106
Country	:	US
Telephone Number	:	201-865-0300
Fax Number	:	201-865-8404

Provider Business Practice Location Address
First Line	:	314 48TH ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5106
Country	:	US
Telephone Number	:	201-865-0300
Fax Number	:	201-865-8404

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/01/2010

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Directions to “ DR. MARIE JEAN DESTEFAN DC” Practice Location

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