MEDICARE: RISING SUN CHIROPRACTIC & REHABILITATION, INC

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	111NR0400X	Rehabilitation Chiropractor	38MC00506000	NJ

General Provider Information

NPI Number	:	1619163250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING SUN CHIROPRACTIC & REHABILITATION, INC

Provider Business Mailing Address
First Line	:	5026 WELLINGTON AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1443
Country	:	US
Telephone Number	:	609-822-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 WELLINGTON AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1443
Country	:	US
Telephone Number	:	609-822-9090
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW B SECHTIN
Credential	:	DC
Telephone Number	:	609-822-9090

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	10/10/2007

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