MEDICARE: DAVID A. DEPAOLIS 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	38MC00458900	NJ

General Provider Information

NPI Number	:	1962610154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A. DEPAOLIS D.C.

Provider Business Mailing Address
First Line	:	82 N FINLEY AVE
Second Line	:
City	:	BASKING RIDGE
State	:	NJ
Zip	:	07920-1145
Country	:	US
Telephone Number	:	908-630-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	266-268 VAN BUREN ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2592
Country	:	US
Telephone Number	:	862-237-7847
Fax Number	:	862-237-7850

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	02/22/2010

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