MEDICARE: ATLANTIC SHORE CHIROPRACTIC 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	261QH0100X	Health Service Clinic/Center	38MC00436600	NJ

General Provider Information

NPI Number	:	1508369158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC SHORE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1325 WARREN AVE STE 8
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2567
Country	:	US
Telephone Number	:	845-774-6810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 WARREN AVE STE 8
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2567
Country	:	US
Telephone Number	:	845-774-6810
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KENNETH TOBEY
Credential	:	DC
Telephone Number	:	845-774-6810

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	03/09/2018

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