MEDICARE: DR. STEPHEN A MATTERA 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	38MC00296800	NJ

General Provider Information

NPI Number	:	1548357957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN A MATTERA DC

Provider Business Mailing Address
First Line	:	1817 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6217
Country	:	US
Telephone Number	:	973-839-0220
Fax Number	:	973-839-4652

Provider Business Practice Location Address
First Line	:	1817 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6217
Country	:	US
Telephone Number	:	973-839-0220
Fax Number	:	973-839-4652

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/07/2008

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