MEDICARE: BC CHIROPRACTIC OFFICES PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000014124	OTHER	NY	EXCELLUS BCBS

General Provider Information

NPI Number	:	1952424426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BC CHIROPRACTIC OFFICES PC

Provider Business Mailing Address
First Line	:	5500 BARTEL RD
Second Line	:
City	:	BREWERTON
State	:	NY
Zip	:	13029-8792
Country	:	US
Telephone Number	:	315-676-4655
Fax Number	:	315-655-4044

Provider Business Practice Location Address
First Line	:	5500 BARTEL RD
Second Line	:
City	:	BREWERTON
State	:	NY
Zip	:	13029-8792
Country	:	US
Telephone Number	:	315-676-4655
Fax Number	:	315-655-4044

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY ANNE TAYLOR-LAMB
Credential	:	DC
Telephone Number	:	315-676-4655

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	11/16/2011

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1457318602 — DR. PAUL C GIASI MD
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1508973785 — KPH HEALTHCARE SERVICES, INC.
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