MEDICARE: DR. WAYNE JONATHAN BASS 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	38MC00612800	NJ

General Provider Information

NPI Number	:	1699789230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE JONATHAN BASS DC

Provider Business Mailing Address
First Line	:	513A VALLEY ST
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-1337
Country	:	US
Telephone Number	:	973-378-2277
Fax Number	:	973-378-8877

Provider Business Practice Location Address
First Line	:	513A VALLEY ST
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-1337
Country	:	US
Telephone Number	:	973-378-2277
Fax Number	:	973-378-8877

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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