MEDICARE: DR. KIMBERLY G CARLUCCI D.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	MC04955	NJ

General Provider Information

NPI Number	:	1346387438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY G CARLUCCI D.C.

Provider Business Mailing Address
First Line	:	86 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2209
Country	:	US
Telephone Number	:	973-744-9880
Fax Number	:	973-744-9883

Provider Business Practice Location Address
First Line	:	86 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2209
Country	:	US
Telephone Number	:	973-744-9880
Fax Number	:	973-744-9883

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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