MEDICARE: GEORGE W. HEATHCOTE DC 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	111N00000X	Chiropractor	2725	OH

General Provider Information

NPI Number	:	1598062457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE W. HEATHCOTE DC INC.

Provider Business Mailing Address
First Line	:	1 S MAIN ST
Second Line	:	SUITE 1
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3225
Country	:	US
Telephone Number	:	440-893-8800
Fax Number	:	440-893-9422

Provider Business Practice Location Address
First Line	:	1 S MAIN ST
Second Line	:	SUITE 1
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3225
Country	:	US
Telephone Number	:	440-893-8800
Fax Number	:	440-893-9422

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEORGE W. HEATHCOTE
Credential	:	D.C.
Telephone Number	:	440-839-8800

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	10/05/2016

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