MEDICARE: DR. J S BEBEE-WILSON 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	111NR0400X	Rehabilitation Chiropractor	DC004809L	PA

General Provider Information

NPI Number	:	1770779357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J S BEBEE-WILSON D.C.

Provider Business Mailing Address
First Line	:	2232 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2617
Country	:	US
Telephone Number	:	215-235-9540
Fax Number	:	215-232-4903

Provider Business Practice Location Address
First Line	:	2232 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2617
Country	:	US
Telephone Number	:	215-235-9540
Fax Number	:	215-232-4903

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	07/19/2012

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