MEDICARE: DR. MARYANNE GUADARA 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	MC 03902	NJ

General Provider Information

NPI Number	:	1912060070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYANNE GUADARA D.C.

Provider Business Mailing Address
First Line	:	7521 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	201-869-9696
Fax Number	:	201-869-9860

Provider Business Practice Location Address
First Line	:	7521 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	201-869-9696
Fax Number	:	201-869-9860

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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