=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598815409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK D. NIERENBERG D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 01/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3322 ROUTE 22 SUITE 1101
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-595-9360
-----------------------------------------------------
Fax | 908-253-0721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3322 ROUTE 22 SUITE 1101
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-595-9360
-----------------------------------------------------
Fax | 908-253-0721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NX0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Chiropractor
-----------------------------------------------------
License Number | 38MC00470600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------