MEDICARE: DR. JAY PLOTKIN 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	111NR0400X	Rehabilitation Chiropractor	2907	OH

General Provider Information

NPI Number	:	1558408625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY PLOTKIN DC

Provider Business Mailing Address
First Line	:	14100 CEDAR ROAD
Second Line	:	SUITE 220
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44121
Country	:	US
Telephone Number	:	216-691-7777
Fax Number	:	216-691-6990

Provider Business Practice Location Address
First Line	:	14100 CEDAR RD
Second Line	:	SUITE 220
City	:	CLEVELAND
State	:	OH
Zip	:	44121-3212
Country	:	US
Telephone Number	:	216-691-7777
Fax Number	:	216-691-6990

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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