MEDICARE: DR. ROBERT ANDREW SUPER 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	38MC00375100	NJ

General Provider Information

NPI Number	:	1720080708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ANDREW SUPER DC

Provider Business Mailing Address
First Line	:	2 LEES LN
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08107-1091
Country	:	US
Telephone Number	:	856-858-5511
Fax Number	:	856-858-2317

Provider Business Practice Location Address
First Line	:	2 LEES LN
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08107-1091
Country	:	US
Telephone Number	:	856-858-5511
Fax Number	:	856-858-2317

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/12/2013

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