MEDICARE: BERGEN 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	38MC00622000	NJ

General Provider Information

NPI Number	:	1790926913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGEN CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	108 JUNIPER ST
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-1314
Country	:	US
Telephone Number	:	201-333-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3450
Country	:	US
Telephone Number	:	201-333-2221
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. BRIAN THOMAS CAPRA
Credential	:	DC
Telephone Number	:	201-333-2221

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	09/22/2009

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