MEDICARE: DR. SHADE D. RATCLIFF D.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	1258	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1827657	OTHER	LA	FIRST HEALTH
2	34482	OTHER	LA	AMERICAN LIFE CARE

General Provider Information

NPI Number	:	1023094232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHADE D. RATCLIFF D.C.

Provider Business Mailing Address
First Line	:	1210 FEDERAL AVE
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-2824
Country	:	US
Telephone Number	:	985-385-1500
Fax Number	:	985-385-1564

Provider Business Practice Location Address
First Line	:	1210 FEDERAL AVE
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-2824
Country	:	US
Telephone Number	:	985-385-1500
Fax Number	:	985-385-1564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/08/2007

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