=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831562511
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIORITY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2015
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 NEWARK ST SUITE 205
-----------------------------------------------------
City | HOBOKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07030-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-533-1077
-----------------------------------------------------
Fax | 201-533-9108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 NEWARK ST SUITE 205
-----------------------------------------------------
City | HOBOKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07030-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-533-1077
-----------------------------------------------------
Fax | 201-533-9108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DINA LEE SGAMBATI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 201-533-1077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00489000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------