MEDICARE: BACK AND BODY PAIN RELIEF LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2000X	Physical Therapy Clinic/Center
2	261QP2300X	Primary Care Clinic/Center
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1336656461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK AND BODY PAIN RELIEF LLC

Provider Business Mailing Address
First Line	:	355 ROUTE 22 STE D
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3511
Country	:	US
Telephone Number	:	908-325-3000
Fax Number	:	908-325-3232

Provider Business Practice Location Address
First Line	:	355 ROUTE 22 STE D
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3511
Country	:	US
Telephone Number	:	908-325-3000
Fax Number	:	908-325-3232

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHAN SIVENDRA
Credential	:	MD
Telephone Number	:	908-325-3000

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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Directions to “BACK AND BODY PAIN RELIEF LLC ” Practice Location

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