MEDICARE: MONMOUTH ASSOCIATED SPINE & REHABILITATION CENTER

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	38MC00513700	NJ
2	111N00000X	Chiropractor	38MC00546300	NJ

General Provider Information

NPI Number	:	1740453992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONMOUTH ASSOCIATED SPINE & REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	49 KENT ROAD
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-2452
Country	:	US
Telephone Number	:	732-901-2928
Fax Number	:	732-901-3980

Provider Business Practice Location Address
First Line	:	49 KENT ROAD
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-2452
Country	:	US
Telephone Number	:	732-901-2928
Fax Number	:	732-901-3980

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. JEFFREY J LEPOIDEVIN
Credential	:	DC
Telephone Number	:	732-901-2928

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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