MEDICARE: DR. MICHAEL ETHAN CHARTOFF D.C.

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	2236	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2691716	OTHER	MA	AETNA
2	794755	OTHER	MA	TUFTS
3	21224282786-01	OTHER	MA	BEECH ST
4	P3197246	OTHER	MA	OXFORD
5	26133	OTHER	MA	FALLEN
6	350446	OTHER	MA	HARVARD PILGRIM
7	Y36585	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1568469005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ETHAN CHARTOFF D.C.

Provider Business Mailing Address
First Line	:	162 BOYLSTON ST
Second Line	:	SUITE 41
City	:	BOSTON
State	:	MA
Zip	:	02116-4613
Country	:	US
Telephone Number	:	617-451-1111
Fax Number	:	617-451-1122

Provider Business Practice Location Address
First Line	:	162 BOYLSTON ST
Second Line	:	SUITE 41
City	:	BOSTON
State	:	MA
Zip	:	02116-4613
Country	:	US
Telephone Number	:	617-451-1111
Fax Number	:	617-451-1122

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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