MEDICARE: DOMINIQUE BARISO D.C., L.AC.

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	38MC00733900	NJ
2	171100000X	Acupuncturist	25MZ00118900	NJ
3	111N00000X	Chiropractor	012834	NY
4	171100000X	Acupuncturist	005784	NY

General Provider Information

NPI Number	:	1043670367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE BARISO D.C., L.AC.

Provider Business Mailing Address
First Line	:	944 WESTSIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6515
Country	:	US
Telephone Number	:	201-432-3693
Fax Number	:

Provider Business Practice Location Address
First Line	:	944 WESTSIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6515
Country	:	US
Telephone Number	:	201-432-3693
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	07/15/2016

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