MEDICARE: DR. BRIAN M WRAITH 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	38MC00622800	NJ
2	111N00000X	Chiropractor	X009946	NY

General Provider Information

NPI Number	:	1699816538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN M WRAITH D.C.

Provider Business Mailing Address
First Line	:	323 BERGEN BLVD
Second Line	:	SUITE 3
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1334
Country	:	US
Telephone Number	:	201-945-2032
Fax Number	:	201-945-8873

Provider Business Practice Location Address
First Line	:	323 BERGEN BLVD
Second Line	:	SUITE 3
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1334
Country	:	US
Telephone Number	:	201-945-2032
Fax Number	:	201-945-8873

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	06/19/2008

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