MEDICARE: CHILLEMI HOLDINGS, LLC

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	38MC00532100	NJ

General Provider Information

NPI Number	:	1720533417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILLEMI HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	544 WASHINGTON AVE
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-3334
Country	:	US
Telephone Number	:	973-759-3050
Fax Number	:	973-759-2046

Provider Business Practice Location Address
First Line	:	12 S HOLMDEL RD
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-2130
Country	:	US
Telephone Number	:	973-759-3050
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MICHAEL CHILLEMI
Credential	:	DC
Telephone Number	:	973-759-3050

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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