MEDICARE: FAMILY CHIROPRACTORS OF MONTCLAIR 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	38MC00367800	NJ

General Provider Information

NPI Number	:	1861615916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CHIROPRACTORS OF MONTCLAIR LLC

Provider Business Mailing Address
First Line	:	39 WATCHUNG PLZ
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-4117
Country	:	US
Telephone Number	:	973-783-5666
Fax Number	:	973-783-7209

Provider Business Practice Location Address
First Line	:	39 WATCHUNG PLZ
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-4117
Country	:	US
Telephone Number	:	973-783-5666
Fax Number	:	973-783-7209

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAYNE MIZRAJI
Credential	:	DC
Telephone Number	:	973-783-5666

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/07/2010

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