=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194985598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXINGTON AVENUE CHIROPRACTIC CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 06/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 LEXINGTON AVE STE A
-----------------------------------------------------
City | EWING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-882-7719
-----------------------------------------------------
Fax | 609-882-7720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 LEXINGTON AVE STE A
-----------------------------------------------------
City | EWING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-882-7719
-----------------------------------------------------
Fax | 609-882-7720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC PHYSICIAN
-----------------------------------------------------
Name | DR. PETER C MADDEN
-----------------------------------------------------
Credential | B.S.,B.T.,M.E.S.,D.C
-----------------------------------------------------
Telephone | 609-882-7719
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | MC00560100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------