MEDICARE: ALBANY CHIROPRACTIC CLINIC

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	27-3312	OR

General Provider Information

NPI Number	:	1609207679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	530 ELLSWORTH ST SW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-2363
Country	:	US
Telephone Number	:	541-926-6911
Fax Number	:	541-926-8573

Provider Business Practice Location Address
First Line	:	530 ELLSWORTH ST SW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-2363
Country	:	US
Telephone Number	:	541-926-6911
Fax Number	:	541-926-8573

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. PHILIP BUCHOVECKY
Credential	:	DC
Telephone Number	:	541-926-6911

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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