=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639421233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NECK AND BACK TREATMENT CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2012
-----------------------------------------------------
Last Update Date | 10/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1670 WHITEHORSE HAMILTON SQUARE RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-587-1881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1670 WHITEHORSE HAMILTON SQUARE RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | MARK BENCIVENGO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 609-587-1881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00700500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------