MEDICARE: LASER THERAPY & CHIROPRACTIC CENTER, INC

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	1977	TN

General Provider Information

NPI Number	:	1124217740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASER THERAPY & CHIROPRACTIC CENTER, INC

Provider Business Mailing Address
First Line	:	524 N UNIVERSITY ST
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-3012
Country	:	US
Telephone Number	:	615-217-8624
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 N UNIVERSITY ST
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-3012
Country	:	US
Telephone Number	:	615-217-8624
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. KELLY N BUCHHOLZ
Credential	:
Telephone Number	:	615-217-8624

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	10/16/2008

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