MEDICARE: DEREK ANDREW VAN BENTHUYSEN 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	MC05589	NJ

General Provider Information

NPI Number	:	1376604728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK ANDREW VAN BENTHUYSEN D.C.

Provider Business Mailing Address
First Line	:	3350 HIGHWAY 138
Second Line	:	STE 227
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9694
Country	:	US
Telephone Number	:	732-280-1800
Fax Number	:	732-280-2323

Provider Business Practice Location Address
First Line	:	3350 HIGHWAY 138
Second Line	:	STE 227
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9694
Country	:	US
Telephone Number	:	732-280-1800
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	03/02/2020

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Directions to “ DEREK ANDREW VAN BENTHUYSEN D.C.” Practice Location

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