MEDICARE: CHITTENDEN COUNTY CHIROPRACTIC 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	006-0001120	VT

General Provider Information

NPI Number	:	1952347775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHITTENDEN COUNTY CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	20 LINCOLN STREET
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3154
Country	:	US
Telephone Number	:	802-879-3900
Fax Number	:	802-879-3511

Provider Business Practice Location Address
First Line	:	20 LINCOLN STREET
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3154
Country	:	US
Telephone Number	:	802-879-3900
Fax Number	:	802-879-3511

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CORY ANDREW PIKE
Credential	:	D.C.
Telephone Number	:	802-879-3900

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/11/2010

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