MEDICARE: MRS. THERESA WARNER DC

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	38MC00434900	NJ

General Provider Information

NPI Number	:	1235317603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA WARNER DC

Provider Business Mailing Address
First Line	:	3201 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3468
Country	:	US
Telephone Number	:	732-295-0707
Fax Number	:	732-295-1166

Provider Business Practice Location Address
First Line	:	3201 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3468
Country	:	US
Telephone Number	:	732-295-0707
Fax Number	:	732-295-1166

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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