MEDICARE: AIRROSTI BUCKEYE, INC.

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

General Provider Information

NPI Number	:	1588923924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRROSTI BUCKEYE, INC.

Provider Business Mailing Address
First Line	:	111 TOWER DR BLDG 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3625
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4568 MAYFIELD RD
Second Line	:	SUITE 204
City	:	CLEVELAND
State	:	OH
Zip	:	44121-4064
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON GARRETT
Credential	:	D.C.
Telephone Number	:	800-404-6050

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	06/27/2023

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