MEDICARE: DR. DANIEL BRAINUM 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	01757	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0217272	OTHER	NJ	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0073721000	OTHER	NJ	AMERIHEALTH
4	112143	OTHER	NJ	AETNA
5	11796	OTHER	NJ	OPERATING ENG. LOCAL #825
6	009249	OTHER	NY	GHI

General Provider Information

NPI Number	:	1790844777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL BRAINUM D.C.

Provider Business Mailing Address
First Line	:	1910 WASHINGTON VALLEY RD
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2026
Country	:	US
Telephone Number	:	732-560-1990
Fax Number	:	732-356-6333

Provider Business Practice Location Address
First Line	:	1910 WASHINGTON VALLEY RD
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2026
Country	:	US
Telephone Number	:	732-560-1990
Fax Number	:	732-356-6333

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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