MEDICARE: ADVANCED CHIROPRACTIC CARE CORP.

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	E4341	OTHER		AHIN SUBMITTER

General Provider Information

NPI Number	:	1043541535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC CARE CORP.

Provider Business Mailing Address
First Line	:	3017 S 70TH ST
Second Line	:	SUITE E
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5049
Country	:	US
Telephone Number	:	479-434-6672
Fax Number	:	479-434-6679

Provider Business Practice Location Address
First Line	:	3017 S 70TH ST
Second Line	:	SUITE E
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5049
Country	:	US
Telephone Number	:	479-434-6672
Fax Number	:	479-434-6679

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD R FLOYD
Credential	:	D.C.
Telephone Number	:	479-434-6672

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	03/04/2010

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Directions to “ADVANCED CHIROPRACTIC CARE CORP. ” Practice Location

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