MEDICARE: MPOWER CHIROPRACTIC WELLNESS CENTER 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	MC00583800	NJ

General Provider Information

NPI Number	:	1437318250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MPOWER CHIROPRACTIC WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	810 BELMONT AVE
Second Line	:	2ND FLOOR
City	:	NORTH HALEDON
State	:	NJ
Zip	:	07508-2357
Country	:	US
Telephone Number	:	973-955-7168
Fax Number	:	973-427-2776

Provider Business Practice Location Address
First Line	:	810 BELMONT AVE
Second Line	:	2ND FLOOR
City	:	NORTH HALEDON
State	:	NJ
Zip	:	07508-2357
Country	:	US
Telephone Number	:	973-955-7168
Fax Number	:	973-427-2776

Authorized Official
Title or Position	:	OWNER
Name	:	MIGUEL PAGAN JR.
Credential	:	D.C.
Telephone Number	:	973-955-7168

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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