MEDICARE: DOWNBEACH CHIROPRACTIC

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	MC005992	NJ

General Provider Information

NPI Number	:	1205166352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNBEACH CHIROPRACTIC

Provider Business Mailing Address
First Line	:	6750 VENTNOR AVE
Second Line	:	COMMERCIAL #2
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2153
Country	:	US
Telephone Number	:	609-412-3561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 VENTNOR AVE
Second Line	:	COMMERCIAL #2
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2153
Country	:	US
Telephone Number	:	609-412-3561
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL GREENBERG
Credential	:
Telephone Number	:	609-412-3561

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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