MEDICARE: DR. DARRELL R KILCUP 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	4935	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0930450	OTHER	AZ	BCBS PIN #

General Provider Information

NPI Number	:	1285633826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL R KILCUP D.C.

Provider Business Mailing Address
First Line	:	7016 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-8402
Country	:	US
Telephone Number	:	602-864-0304
Fax Number	:	602-864-0990

Provider Business Practice Location Address
First Line	:	7016 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-8402
Country	:	US
Telephone Number	:	602-864-0304
Fax Number	:	602-864-0990

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	06/16/2008

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