MEDICARE: MARK E DEITCH DC

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 05659	NJ
2	111N00000X	Chiropractor	CH 6617	FL
3	111N00000X	Chiropractor	X009747-1	NY
4	111N00000X	Chiropractor	5043	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922173863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E DEITCH DC

Provider Business Mailing Address
First Line	:	50 PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE D
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1107
Country	:	US
Telephone Number	:	609-897-1200
Fax Number	:	609-897-0900

Provider Business Practice Location Address
First Line	:	50 PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE D
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1107
Country	:	US
Telephone Number	:	609-897-1200
Fax Number	:	609-897-0900

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	11/06/2007

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Directions to “ MARK E DEITCH DC” Practice Location

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