MEDICARE: FIRST CHIROPRACTIC CENTERS, PC

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	:	1699210344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHIROPRACTIC CENTERS, PC

Provider Business Mailing Address
First Line	:	PO BOX 541
Second Line	:	110 E MAIN ST
City	:	BLOOMFIELD
State	:	NE
Zip	:	68718-0541
Country	:	US
Telephone Number	:	402-408-6769
Fax Number	:	402-408-6253

Provider Business Practice Location Address
First Line	:	110 E MAIN ST
Second Line	:
City	:	BLOOMFIELD
State	:	NE
Zip	:	68718-4408
Country	:	US
Telephone Number	:	402-408-6769
Fax Number	:	402-408-6253

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. THOMAS D STOTZ
Credential	:	DC
Telephone Number	:	605-665-8073

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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