=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285013045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA PATRICIA DILBA DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2015
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 N MAPLE AVE G2
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-983-5422
-----------------------------------------------------
Fax | 856-983-6579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 N MAPLE AVE G2
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-983-5422
-----------------------------------------------------
Fax | 856-983-6579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00726300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------