MEDICARE: DR. LINDA MANDATA DIBARTOLO D.C.

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	38MCOO3552	NJ

General Provider Information

NPI Number	:	1528169786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA MANDATA DIBARTOLO D.C.

Provider Business Mailing Address
First Line	:	4036 OCEAN HEIGHTS AVE
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-7505
Country	:	US
Telephone Number	:	609-926-1100
Fax Number	:	609-926-0054

Provider Business Practice Location Address
First Line	:	4036 OCEAN HEIGHTS AVE
Second Line	:
City	:	EGG HARBOR TWP
State	:	NJ
Zip	:	08234-7505
Country	:	US
Telephone Number	:	609-926-1100
Fax Number	:	609-926-0054

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/09/2007

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