MEDICARE: HEALTHWAVE CHIROPRACTIC, LLC

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	38MC00408100	NJ

General Provider Information

NPI Number	:	1235445750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWAVE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	3109 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3455
Country	:	US
Telephone Number	:	732-714-9283
Fax Number	:	732-714-9557

Provider Business Practice Location Address
First Line	:	3109 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3455
Country	:	US
Telephone Number	:	732-714-9283
Fax Number	:	732-714-9557

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC FRANKENFELD
Credential	:
Telephone Number	:	732-714-9283

Provider Enumeration Date	:	08/21/2010
Last Update Date	:	08/21/2010

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