MEDICARE: TRICOUNTY COUNTY CHIROPRACTIC

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

General Provider Information

NPI Number	:	1023131430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICOUNTY COUNTY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	5612 SW GREEN OAKS BLVD STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1154
Country	:	US
Telephone Number	:	817-676-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5612 SW GREEN OAKS BLVD STE B
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1154
Country	:	US
Telephone Number	:	817-676-3987
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	RAYNA MILES
Credential	:
Telephone Number	:	817-932-7066

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	01/12/2014

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Directions to “TRICOUNTY COUNTY CHIROPRACTIC ” Practice Location

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