MEDICARE: EAGAR FAMILY 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	111N00000X	Chiropractor	8235	AZ

General Provider Information

NPI Number	:	1578838397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGAR FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	674 W CENTRAL AVE
Second Line	:
City	:	EAGAR
State	:	AZ
Zip	:	85925-9706
Country	:	US
Telephone Number	:	928-333-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	674 W CENTRAL AVE
Second Line	:
City	:	EAGAR
State	:	AZ
Zip	:	85925-9706
Country	:	US
Telephone Number	:	928-333-2225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN M EAGAR
Credential	:	DC
Telephone Number	:	928-551-5107

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	04/05/2012

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