MEDICARE: ADVANCED CHIROPRACTIC CENTER, 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	38MC00341200	NJ

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	:	1982893558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC CENTER, PA

Provider Business Mailing Address
First Line	:	2123 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-662-4455
Fax Number	:	856-662-5600

Provider Business Practice Location Address
First Line	:	2123 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-662-4455
Fax Number	:	856-662-5600

Authorized Official
Title or Position	:	ASS'T OFFICE MANAGER
Name	:	MS. DENISE GRAZIOLI
Credential	:
Telephone Number	:	856-662-4455

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	04/15/2008

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