=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871782821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORE CHRIPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2007
-----------------------------------------------------
Last Update Date | 10/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 SHEPHERD CIR
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08225-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-646-0578
-----------------------------------------------------
Fax | 609-646-9289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 SHEPHERD CIR
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08225-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-646-0578
-----------------------------------------------------
Fax | 609-646-9289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DAVID L HADLEY
-----------------------------------------------------
Credential | D. C.
-----------------------------------------------------
Telephone | 609-646-0578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00243800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------