MEDICARE: DR. MARK J. SCANLON 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	1961	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000020360	OTHER	OH	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871676023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J. SCANLON D.C.

Provider Business Mailing Address
First Line	:	9494 CINCINNATI COLUMBUS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1161
Country	:	US
Telephone Number	:	513-755-8020
Fax Number	:	513-755-8021

Provider Business Practice Location Address
First Line	:	9494 CINCINNATI COLUMBUS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1161
Country	:	US
Telephone Number	:	513-755-8020
Fax Number	:	513-755-8021

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/19/2012

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