MEDICARE: DR. JESSE ELSHOLZ D.C.

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	X011327	NY

General Provider Information

NPI Number	:	1104974344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE ELSHOLZ D.C.

Provider Business Mailing Address
First Line	:	52 STEVENS AVE
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-2837
Country	:	US
Telephone Number	:	908-334-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 W MAIN ST
Second Line	:
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-2211
Country	:	US
Telephone Number	:	516-922-4606
Fax Number	:	516-922-4399

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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