=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427086602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH ANTHONY SANTICERMA D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 E SOMERSET ST
-----------------------------------------------------
City | RARITAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08869-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-541-1234
-----------------------------------------------------
Fax | 908-541-1210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 E SOMERSET ST
-----------------------------------------------------
City | RARITAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08869-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-541-1234
-----------------------------------------------------
Fax | 908-541-1210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00541300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------