MEDICARE: DR. IAN BULOW D.C

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	DC009926	PA

General Provider Information

NPI Number	:	1619144938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN BULOW D.C

Provider Business Mailing Address
First Line	:	168 JAMESON WAY
Second Line	:
City	:	SEVEN FIELDS
State	:	PA
Zip	:	16046-4350
Country	:	US
Telephone Number	:	724-553-8526
Fax Number	:

Provider Business Practice Location Address
First Line	:	20808 ROUTE 19
Second Line	:	SUITE C
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-6022
Country	:	US
Telephone Number	:	724-553-8526
Fax Number	:

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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