MEDICARE: DR. GEORGE W HEATHCOTE DC

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	111NS0005X	Sports Physician Chiropractor	2725	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	582433402	OTHER	OH	TAX I.D.

General Provider Information

NPI Number	:	1407889918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE W HEATHCOTE DC

Provider Business Mailing Address
First Line	:	1 S MAIN ST
Second Line	:	SUITE 1
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3225
Country	:	US
Telephone Number	:	440-893-8800
Fax Number	:	440-893-9422

Provider Business Practice Location Address
First Line	:	1 S MAIN ST STE 1
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3225
Country	:	US
Telephone Number	:	440-893-8800
Fax Number	:	440-893-9422

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	05/23/2013

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