=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487806618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAKACS CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2008
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 STATE ROUTE 15
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07848-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-383-5052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 STATE ROUTE 15
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07848-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-383-5052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | MICHELE TAKACS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 973-383-5052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | MC02840
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------