MEDICARE: MONTCLAIR UPPER CERVICAL CHIROPRACTIC, 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	38MC00262300	NJ

General Provider Information

NPI Number	:	1790118040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTCLAIR UPPER CERVICAL CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	41 PLYMOUTH ST
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2617
Country	:	US
Telephone Number	:	973-744-3456
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 PLYMOUTH ST
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2617
Country	:	US
Telephone Number	:	973-744-3456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARGARET BANITCH
Credential	:	DC
Telephone Number	:	973-744-3456

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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