MEDICARE: DIBARTOLO CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00311300	NJ

General Provider Information

NPI Number	:	1043373640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIBARTOLO CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	4036 OCEAN HEIGHTS AVE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7505
Country	:	US
Telephone Number	:	609-926-1100
Fax Number	:	609-926-0054

Provider Business Practice Location Address
First Line	:	4036 OCEAN HEIGHTS AVE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7505
Country	:	US
Telephone Number	:	609-926-1100
Fax Number	:	609-926-0054

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DR. PHILIP ANTHONY DIBARTOLO
Credential	:	DC
Telephone Number	:	609-926-1100

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/27/2016

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