MEDICARE: THE COLUMBUS CLINIC OF CHIROPRACTIC P.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	08002261A	IN

General Provider Information

NPI Number	:	1962633248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COLUMBUS CLINIC OF CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	4010 W GOELLER BLVD
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8892
Country	:	US
Telephone Number	:	812-342-0600
Fax Number	:	812-342-0601

Provider Business Practice Location Address
First Line	:	4010 W GOELLER BLVD
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8892
Country	:	US
Telephone Number	:	812-342-0600
Fax Number	:	812-342-0601

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JARED EDWARD CRAWFORD
Credential	:	D.C.
Telephone Number	:	812-342-0600

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	10/09/2009

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