MEDICARE: 5 STAR CHIROPRACTIC, LLC

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	302F00000X	Exclusive Provider Organization	20070007093	MO

General Provider Information

NPI Number	:	1477795490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1601 E 9TH ST
Second Line	:	STE. E
City	:	TRENTON
State	:	MO
Zip	:	64683-2763
Country	:	US
Telephone Number	:	816-500-8457
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 E 9TH ST
Second Line	:	STE. E
City	:	TRENTON
State	:	MO
Zip	:	64683-2763
Country	:	US
Telephone Number	:	816-500-8457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER M MERCER
Credential	:	DC
Telephone Number	:	816-500-8457

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	05/03/2010

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