MEDICARE: DR. JILL BAND LANDIS 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	111NR0400X	Rehabilitation Chiropractor	DC007234L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1676244	OTHER	PA	GROUP NUMBER
2	2214751	OTHER	PA	AETNA PROVIDER #

General Provider Information

NPI Number	:	1760542179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL BAND LANDIS D.C.

Provider Business Mailing Address
First Line	:	44 2ND STREET PIKE
Second Line	:	SUITE 202
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3830
Country	:	US
Telephone Number	:	215-942-9429
Fax Number	:	215-942-9432

Provider Business Practice Location Address
First Line	:	44 2ND STREET PIKE
Second Line	:	SUITE 202
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3830
Country	:	US
Telephone Number	:	215-942-9429
Fax Number	:	215-942-9432

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/09/2007

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