MEDICARE: SUMMIT CHIROPRACTIC CLINIC 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

General Provider Information

NPI Number	:	1609101948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT CHIROPRACTIC CLINIC LLC

Provider Business Mailing Address
First Line	:	3350 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3636
Country	:	US
Telephone Number	:	517-783-5805
Fax Number	:	517-783-4287

Provider Business Practice Location Address
First Line	:	3350 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3636
Country	:	US
Telephone Number	:	517-783-5805
Fax Number	:	517-783-4287

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ANDREW CARL CHALFANT
Credential	:	D.C.
Telephone Number	:	517-783-5805

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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