MEDICARE: HAINESPORT CHIROPRACTIC PA

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	38MC00132300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0037664	OTHER	NJ	AETNA
2	0091517000	OTHER	NJ	BLUE SHIELD

General Provider Information

NPI Number	:	1922060854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAINESPORT CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	2717 MARNE HIGHWAY
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036
Country	:	US
Telephone Number	:	609-267-5550
Fax Number	:	609-267-3535

Provider Business Practice Location Address
First Line	:	2717 MARNE HIGHWAY
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036
Country	:	US
Telephone Number	:	609-267-5550
Fax Number	:	609-267-3535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN E LONGO
Credential	:	DC
Telephone Number	:	609-267-5550

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/25/2008

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Directions to “HAINESPORT CHIROPRACTIC PA ” Practice Location

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