MEDICARE: DR. JOHN KIM 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	38MC00613700	NJ

General Provider Information

NPI Number	:	1558413179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KIM D.C.

Provider Business Mailing Address
First Line	:	2357 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6229
Country	:	US
Telephone Number	:	201-823-4330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2357 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6229
Country	:	US
Telephone Number	:	201-944-4552
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN KIM D.C.” Practice Location

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