MEDICARE: TRI-CITY CHIROPRACTIC CLINIC,P.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	2410	OK

General Provider Information

NPI Number	:	1770772162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITY CHIROPRACTIC CLINIC,P.C.

Provider Business Mailing Address
First Line	:	3607 NW 32ND ST
Second Line	:
City	:	NEWCASTLE
State	:	OK
Zip	:	73065-6559
Country	:	US
Telephone Number	:	405-392-5504
Fax Number	:	405-392-5501

Provider Business Practice Location Address
First Line	:	3607 NW 32ND ST
Second Line	:
City	:	NEWCASTLE
State	:	OK
Zip	:	73065-6559
Country	:	US
Telephone Number	:	405-392-5504
Fax Number	:	405-392-5501

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. STEPHEN W MCCAN
Credential	:	D.C.
Telephone Number	:	405-392-5504

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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