MEDICARE: THE CHIROPRACTIC COMPANY, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114031317	OTHER	AZ	GROUP NUMBER Z23051

General Provider Information

NPI Number	:	1114031317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHIROPRACTIC COMPANY, PLLC

Provider Business Mailing Address
First Line	:	4022 E GREENWAY RD
Second Line	:	SUITE 1
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4797
Country	:	US
Telephone Number	:	602-493-0004
Fax Number	:	602-493-0761

Provider Business Practice Location Address
First Line	:	4022 E GREENWAY RD
Second Line	:	SUITE 1
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4797
Country	:	US
Telephone Number	:	602-493-0004
Fax Number	:	602-493-0761

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY A LYNN
Credential	:	DC
Telephone Number	:	602-493-0004

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/09/2008

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