MEDICARE: DR. ANDREW CARL CHALFANT 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	2301005934	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950C85123	OTHER	MI	BCBS PROVIDER NUMBER
2	AC005934	OTHER	MI	BCBS REFERRING PROVIDER #

General Provider Information

NPI Number	:	1730148594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CARL CHALFANT D.C.

Provider Business Mailing Address
First Line	:	3350 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3636
Country	:	US
Telephone Number	:	517-783-5805
Fax Number	:	517-783-5805

Provider Business Practice Location Address
First Line	:	3350 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3636
Country	:	US
Telephone Number	:	517-783-5805
Fax Number	:	517-783-5805

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/09/2007

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