MEDICARE: BLISS CHIROPRACTIC AND REHAB CLINIC 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	38MC00684200	NJ

General Provider Information

NPI Number	:	1528306412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISS CHIROPRACTIC AND REHAB CLINIC PC

Provider Business Mailing Address
First Line	:	1506 HUDSON PARK
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 HUDSON PARK
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020
Country	:	US
Telephone Number	:	703-581-9552
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HONGSOON LIM
Credential	:	D.C
Telephone Number	:	703-581-9552

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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