MEDICARE: DR. PAUL ERIC TSCHETSCHOT DC

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	0104556485	VA

General Provider Information

NPI Number	:	1639159163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ERIC TSCHETSCHOT DC

Provider Business Mailing Address
First Line	:	34 MEDICAL PARK BLVD
Second Line	:	SUITE C
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9283
Country	:	US
Telephone Number	:	804-862-2255
Fax Number	:	804-862-1004

Provider Business Practice Location Address
First Line	:	34 MEDICAL PARK BLVD
Second Line	:	SUITE C
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9283
Country	:	US
Telephone Number	:	804-862-2255
Fax Number	:	804-862-1004

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/19/2012

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