MEDICARE: CHIROPRACTIC HEALTH & FITNESS

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	:	1740302272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC HEALTH & FITNESS

Provider Business Mailing Address
First Line	:	1315 HIGHWAY 1187 STE 101
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6134
Country	:	US
Telephone Number	:	817-473-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 HIGHWAY 1187 STE 101
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6134
Country	:	US
Telephone Number	:	817-473-6151
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	RAYNA REED
Credential	:
Telephone Number	:	817-987-1466

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	03/04/2008

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