MEDICARE: DR. TINA MARIE DRISCOLL 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	1830	NC

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	013FC	OTHER	NC	BCBS PROVIDER NO.

General Provider Information

NPI Number	:	1083611040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA MARIE DRISCOLL D.C.

Provider Business Mailing Address
First Line	:	508 GLENOLA ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-3206
Country	:	US
Telephone Number	:	910-822-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 N BRAGG BLVD
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-3116
Country	:	US
Telephone Number	:	910-436-5000
Fax Number	:	910-436-7705

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/08/2007

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