MEDICARE: DR. CAROL W. BOOTH CHIROPRACTOR

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	5575	TX

General Provider Information

NPI Number	:	1104835438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL W. BOOTH CHIROPRACTOR

Provider Business Mailing Address
First Line	:	1621 W PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-3502
Country	:	US
Telephone Number	:	817-460-4644
Fax Number	:	817-460-4641

Provider Business Practice Location Address
First Line	:	1621 W PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-3502
Country	:	US
Telephone Number	:	817-460-4644
Fax Number	:	817-460-4641

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/04/2013

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