MEDICARE: DR. CARL DEMMIE 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	38MC00554800	NJ

General Provider Information

NPI Number	:	1689827669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL DEMMIE D.C.

Provider Business Mailing Address
First Line	:	357 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1654
Country	:	US
Telephone Number	:	973-546-5440
Fax Number	:	973-546-5459

Provider Business Practice Location Address
First Line	:	357 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1654
Country	:	US
Telephone Number	:	973-546-5440
Fax Number	:	973-546-5459

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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