MEDICARE: BIRCHWOOD CHIROPRACTIC CENTER, PLLC

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	:	1649317967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRCHWOOD CHIROPRACTIC CENTER, PLLC

Provider Business Mailing Address
First Line	:	4040 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3800
Country	:	US
Telephone Number	:	810-385-0235
Fax Number	:	810-385-0239

Provider Business Practice Location Address
First Line	:	4040 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3800
Country	:	US
Telephone Number	:	810-385-0235
Fax Number	:	810-385-0239

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH LUPO
Credential	:	D.C.
Telephone Number	:	810-385-0235

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	04/20/2008

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