MEDICARE: MASTERSON CHIROPRACTIC PC

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	38MC00633000	NJ

General Provider Information

NPI Number	:	1497936793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTERSON CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1200 RIVER AVE
Second Line	:	SUITE 2B
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5657
Country	:	US
Telephone Number	:	732-370-3300
Fax Number	:	732-370-5499

Provider Business Practice Location Address
First Line	:	1200 RIVER AVE
Second Line	:	SUITE 2B
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5657
Country	:	US
Telephone Number	:	732-370-3300
Fax Number	:	732-370-5499

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	EDWARD P MASTERSON
Credential	:
Telephone Number	:	732-370-3300

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	03/20/2008

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