MEDICARE: TROY CHIROPRACTIC AND PHYSICAL MEDICINE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1316318322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TROY CHIROPRACTIC AND PHYSICAL MEDICINE INC

Provider Business Mailing Address
First Line	:	51 S STANFIELD RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2992
Country	:	US
Telephone Number	:	937-335-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 S STANFIELD RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2992
Country	:	US
Telephone Number	:	937-335-2722
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	LINDSAY LANDENBERGER
Credential	:
Telephone Number	:	614-305-5064

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

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