MEDICARE: MICHAEL W GERVIS 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	2138	NJ

General Provider Information

NPI Number	:	1710961222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W GERVIS DC

Provider Business Mailing Address
First Line	:	50 PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE D
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1107
Country	:	US
Telephone Number	:	609-897-0009
Fax Number	:	609-897-0900

Provider Business Practice Location Address
First Line	:	50 PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE D
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1107
Country	:	US
Telephone Number	:	609-897-0009
Fax Number	:	609-897-0900

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	04/22/2009

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