MEDICARE: DR. JESSE MATTHEW WEST

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	006.0117178	VT

General Provider Information

NPI Number	:	1558738617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE MATTHEW WEST

Provider Business Mailing Address
First Line	:	1151 W MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VT
Zip	:	05477-4472
Country	:	US
Telephone Number	:	802-434-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 W MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VT
Zip	:	05477-4472
Country	:	US
Telephone Number	:	802-434-5437
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	02/29/2016

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