MEDICARE: JOSEPH CHARLES DE FAZIO 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	MC001673	NJ

General Provider Information

NPI Number	:	1144277336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHARLES DE FAZIO D.C.

Provider Business Mailing Address
First Line	:	14 E PARK PL
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2314
Country	:	US
Telephone Number	:	201-460-1643
Fax Number	:	201-438-7084

Provider Business Practice Location Address
First Line	:	549 SUMMIT AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2701
Country	:	US
Telephone Number	:	201-533-1004
Fax Number	:	201-533-1008

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	03/03/2009

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