MEDICARE: RAINVILLE CHIROPRACTIC, PLLC

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	006.0057138	VT
2	111N00000X	Chiropractor	006.0084296	VT

General Provider Information

NPI Number	:	1407122831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINVILLE CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	25 CATHERINE ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-2205
Country	:	US
Telephone Number	:	802-524-4600
Fax Number	:	802-524-4700

Provider Business Practice Location Address
First Line	:	25 CATHERINE ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-2205
Country	:	US
Telephone Number	:	802-524-4600
Fax Number	:	802-524-4700

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. MARTHA R RAINVILLE
Credential	:	DC
Telephone Number	:	802-524-4600

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	07/30/2013

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