MEDICARE: DR. WILLIAM J. GANNON 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	111N00000X	Chiropractor	38MC00264900	NJ

General Provider Information

NPI Number	:	1902832769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J. GANNON D.C.

Provider Business Mailing Address
First Line	:	2 SPLIT ROCK DR
Second Line	:	SUITE 1
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1244
Country	:	US
Telephone Number	:	856-424-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 SPLIT ROCK DR
Second Line	:	SUITE 1
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1244
Country	:	US
Telephone Number	:	856-424-9220
Fax Number	:	856-424-5319

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/10/2010

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