MEDICARE: MIDWEST CHIROPRACTIC CENTER LLC

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	111NR0400X	Rehabilitation Chiropractor	1454	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311274667-00	OTHER	OH	BWC PROVIDER NUMBER

General Provider Information

NPI Number	:	1053533513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	6104 HUNTLEY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1004
Country	:	US
Telephone Number	:	614-847-9667
Fax Number	:	614-847-9688

Provider Business Practice Location Address
First Line	:	6104 HUNTLEY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1004
Country	:	US
Telephone Number	:	614-847-9667
Fax Number	:	614-847-9688

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. PETER J MANZ
Credential	:	D.C.
Telephone Number	:	614-847-9667

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	05/13/2016

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6104 HUNTLEY RD
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43229-1004

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1609835248 — BRANDI J RAPPAPORT MD
Practice Location Address:

45 HOMESTEAD DR , SUITE B
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1891816054 — PUCCIO CHIROPRACTIC LLC
Practice Location Address:

45 HOMESTEAD DR , SUITE A
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Directions to “MIDWEST CHIROPRACTIC CENTER LLC ” Practice Location

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