MEDICARE: DR. ALEXANDER W SHEPPARD 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	111N00000X	Chiropractor	4316	MN

General Provider Information

NPI Number	:	1588655286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER W SHEPPARD DC

Provider Business Mailing Address
First Line	:	7424 E POINT DOUGLAS RD S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7424 E POINT DOUGLAS RD S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3025
Country	:	US
Telephone Number	:	651-458-5565
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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