MEDICARE: JOHN ANASTASIOS KIRIAKATIS 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	38MC00411500	NJ

General Provider Information

NPI Number	:	1548378359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ANASTASIOS KIRIAKATIS DC

Provider Business Mailing Address
First Line	:	1042 SALEM RD
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083
Country	:	US
Telephone Number	:	908-964-3331
Fax Number	:	908-964-4687

Provider Business Practice Location Address
First Line	:	1042 SALEM RD
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083
Country	:	US
Telephone Number	:	908-964-3331
Fax Number	:	908-964-4687

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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