MEDICARE: FAMILY CARE CHIROPRACTIC, P.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

General Provider Information

NPI Number	:	1336479203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-0051
Country	:	US
Telephone Number	:	732-462-0049
Fax Number	:	732-462-0059

Provider Business Practice Location Address
First Line	:	420 ROUTE 34 STE 331
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-2517
Country	:	US
Telephone Number	:	732-462-0049
Fax Number	:	732-462-0059

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. JOHN A PANICALI
Credential	:	D.C.
Telephone Number	:	732-462-0049

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	12/28/2009

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