MEDICARE: DR. JOSEPH YSBRAND 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	9831	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8V4990	OTHER	TX	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1033225461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH YSBRAND D.C.

Provider Business Mailing Address
First Line	:	6789 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7112
Country	:	US
Telephone Number	:	817-731-2102
Fax Number	:	817-731-2157

Provider Business Practice Location Address
First Line	:	6789 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7112
Country	:	US
Telephone Number	:	817-731-2102
Fax Number	:	817-731-2157

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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