MEDICARE: DR. JASON JAMES PELOQUIN 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	X011068	NY

General Provider Information

NPI Number	:	1366648214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON JAMES PELOQUIN DC

Provider Business Mailing Address
First Line	:	181 ADA DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1416
Country	:	US
Telephone Number	:	718-715-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	277 88TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5609
Country	:	US
Telephone Number	:	718-833-9355
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	02/05/2008

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