MEDICARE: LUIS MIZRAJI 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	38MC00367800	NJ

General Provider Information

NPI Number	:	1467521252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS MIZRAJI DC

Provider Business Mailing Address
First Line	:	39 WATCHUNG PLZ
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-4117
Country	:	US
Telephone Number	:	973-783-5666
Fax Number	:	973-783-7209

Provider Business Practice Location Address
First Line	:	39 WATCHUNG PLZ
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-4117
Country	:	US
Telephone Number	:	973-783-5666
Fax Number	:	973-783-7209

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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Directions to “ LUIS MIZRAJI DC” Practice Location

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