MEDICARE: CHADWELL FAMILY CHIROPRACTIC

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	:	1649535006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHADWELL FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	432 W M 55
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-8991
Fax Number	:	989-362-6237

Provider Business Practice Location Address
First Line	:	432 W M 55
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-8991
Fax Number	:	989-362-6237

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. CLINTON M CHADWELL
Credential	:	D.C.
Telephone Number	:	989-362-8991

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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