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NPI Code Detail

MEDICARE: SM CHIROPRACTIC PC

MEDICARE: SM CHIROPRACTIC PC
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
1171100000XAcupuncturist25MZ00081300NJ
2111N00000XChiropractor38MC00648800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11184988107OTHERNJNPI

General Provider Information

NPI Number : 1356764492
Entity Type Code : Organization
Provider Name (Legal Business Name) : SM CHIROPRACTIC PC
Provider Business Mailing Address
First Line : 2460 LEMOINE AVE STE 203
Second Line :
City : FORT LEE
State : NJ
Zip : 07024-6210
Country : US
Telephone Number : 201-559-5307
Fax Number : 201-351-4787
Provider Business Practice Location Address
First Line : 2460 LEMOINE AVE STE 203
Second Line :
City : FORT LEE
State : NJ
Zip : 07024-6210
Country : US
Telephone Number : 201-559-5307
Fax Number : 201-351-4787
Authorized Official
Title or Position : PRESIDENT
Name : SANGROK MOON
Credential : DC, L.AC.
Telephone Number : 201-410-9293
Provider Enumeration Date : 01/25/2014
Last Update Date : 04/27/2020

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Directions to “SM CHIROPRACTIC PC ” Practice Location

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