MEDICARE: AIRROSTI CENTER, INC.

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	111NS0005X	Sports Physician Chiropractor
2	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1902088594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRROSTI CENTER, INC.

Provider Business Mailing Address
First Line	:	7410 BLANCO RD
Second Line	:	SUITE 400
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4363
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 BLANCO RD
Second Line	:	SUITE 400
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4363
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KELLY E GREEN
Credential	:
Telephone Number	:	800-404-6050

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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