MEDICARE: DR. JOHN A GAGLIARDI DC

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	38MC00274000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0073760000	OTHER		AMERIHEALTH

General Provider Information

NPI Number	:	1356362834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A GAGLIARDI DC

Provider Business Mailing Address
First Line	:	295 SHELL RD
Second Line	:
City	:	CARNEYS POINT
State	:	NJ
Zip	:	08069-2600
Country	:	US
Telephone Number	:	856-299-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 SHELL RD
Second Line	:
City	:	CARNEYS POINT
State	:	NJ
Zip	:	08069-2600
Country	:	US
Telephone Number	:	856-299-4070
Fax Number	:	856-299-0290

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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