MEDICARE: TINA SIGNE AXELSSON 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	2768	NC
2	111N00000X	Chiropractor	2423	SC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PB197Q	OTHER	NC	STRATUS
4	M451	OTHER	NC	EDI
5	0845G	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1043326903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA SIGNE AXELSSON DC

Provider Business Mailing Address
First Line	:	7290 13 BEACH DRIVE SW
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469
Country	:	US
Telephone Number	:	910-579-4888
Fax Number	:	910-579-4888

Provider Business Practice Location Address
First Line	:	7290 13 BEACH DRIVE SW
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469
Country	:	US
Telephone Number	:	910-579-4888
Fax Number	:	910-579-4888

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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Directions to “ TINA SIGNE AXELSSON DC” Practice Location

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