MEDICARE: OGATA CHIROPRACTIC 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	CHIA920	ID

General Provider Information

NPI Number	:	1396982567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OGATA CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	5418 N EAGLE RD
Second Line	:	SUITE 120
City	:	BOISE
State	:	ID
Zip	:	83713-0998
Country	:	US
Telephone Number	:	208-938-3334
Fax Number	:	208-938-3335

Provider Business Practice Location Address
First Line	:	5418 N EAGLE RD
Second Line	:	SUITE 120
City	:	BOISE
State	:	ID
Zip	:	83713-0998
Country	:	US
Telephone Number	:	208-938-3334
Fax Number	:	208-938-3335

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	TY OGATA
Credential	:	DC
Telephone Number	:	208-938-3334

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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