MEDICARE: CASTALIA 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	111NN1001X	Nutrition Chiropractor	401	OH

General Provider Information

NPI Number	:	1518150895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTALIA CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	8208 ROGERS RD
Second Line	:
City	:	CASTALIA
State	:	OH
Zip	:	44824-9232
Country	:	US
Telephone Number	:	419-684-7195
Fax Number	:	419-684-7147

Provider Business Practice Location Address
First Line	:	8208 ROGERS RD
Second Line	:
City	:	CASTALIA
State	:	OH
Zip	:	44824-9232
Country	:	US
Telephone Number	:	419-684-7195
Fax Number	:	419-684-7147

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DAN L WHITE
Credential	:	M. S. D.C.
Telephone Number	:	419-684-7195

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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