MEDICARE: HOBOKEN CHIROPRACTIC AND WELLNESS INC

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	261Q00000X	Clinic/Center	38MC00614700	NJ

General Provider Information

NPI Number	:	1457686552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOBOKEN CHIROPRACTIC AND WELLNESS INC

Provider Business Mailing Address
First Line	:	50 HARRISON ST
Second Line	:	SUITE 316
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6064
Country	:	US
Telephone Number	:	201-792-3544
Fax Number	:	201-792-3343

Provider Business Practice Location Address
First Line	:	50 HARRISON ST
Second Line	:	SUITE 316
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6064
Country	:	US
Telephone Number	:	201-792-3544
Fax Number	:	201-792-3343

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAURA T BRAYTON
Credential	:	D.C.
Telephone Number	:	201-792-3544

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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