MEDICARE: DR. JERRY SANDERS 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	38MC00139300	NJ

General Provider Information

NPI Number	:	1922179530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY SANDERS D.C.

Provider Business Mailing Address
First Line	:	539 PASSAIC AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1211
Country	:	US
Telephone Number	:	973-473-2066
Fax Number	:	973-473-6399

Provider Business Practice Location Address
First Line	:	539 PASSAIC AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1211
Country	:	US
Telephone Number	:	973-473-2066
Fax Number	:	973-473-6399

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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