MEDICARE: SOUTH JERSEY SPINE & REHABILITATION 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

General Provider Information

NPI Number	:	1255621041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH JERSEY SPINE & REHABILITATION LLC

Provider Business Mailing Address
First Line	:	275 HADDON AVE
Second Line	:	SUITE C
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-1121
Country	:	US
Telephone Number	:	856-240-7361
Fax Number	:	856-240-7374

Provider Business Practice Location Address
First Line	:	275 HADDON AVE
Second Line	:	SUITE C
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-1121
Country	:	US
Telephone Number	:	856-240-7361
Fax Number	:	856-240-7374

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	EUNICE GIANG
Credential	:
Telephone Number	:	856-240-7361

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/13/2011

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