MEDICARE: VILLAGE CHIROPRACTIC 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	111N00000X	Chiropractor	DCP00453	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	672442	OTHER	RI	UNITED HEALTHCARE
2	275376	OTHER	RI	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1932233277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	55 BOSTON NECK RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5704
Country	:	US
Telephone Number	:	401-667-7700
Fax Number	:	401-667-7701

Provider Business Practice Location Address
First Line	:	55 BOSTON NECK RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5704
Country	:	US
Telephone Number	:	401-667-7700
Fax Number	:	401-667-7701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK A COSEGLIA SR.
Credential	:	D.C.
Telephone Number	:	401-667-7700

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/31/2009

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