MEDICARE: CASEY KLINGERT DC 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	38MC00660200	NJ

General Provider Information

NPI Number	:	1346660115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASEY KLINGERT DC LLC

Provider Business Mailing Address
First Line	:	1319 OLD ZION RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7638
Country	:	US
Telephone Number	:	609-412-7898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 OLD ZION RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7638
Country	:	US
Telephone Number	:	609-653-1100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CASEY JOSEPH KLINGERT
Credential	:	D.C.
Telephone Number	:	609-412-7898

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	11/24/2014

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