MEDICARE: MCINTOSH FAMILY CHIROPRACTIC

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	4850	MN

General Provider Information

NPI Number	:	1124223359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCINTOSH FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	PO BOX 182
Second Line	:	250 CLEVELAND AVE
City	:	MCINTOSH
State	:	MN
Zip	:	56556
Country	:	US
Telephone Number	:	218-289-3478
Fax Number	:	218-563-2043

Provider Business Practice Location Address
First Line	:	250 CLEVELAND AVE
Second Line	:
City	:	MCINTOSH
State	:	MN
Zip	:	56556
Country	:	US
Telephone Number	:	218-289-3478
Fax Number	:	218-563-2043

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	JODIE MARIE OSMONSON
Credential	:	DC
Telephone Number	:	218-289-3478

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	10/11/2007

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