MEDICARE: PARAGON CHIROPRACTIC INC

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	4239	AZ

General Provider Information

NPI Number	:	1053571059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAGON CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	1628 E BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2515
Country	:	US
Telephone Number	:	602-230-9292
Fax Number	:	602-230-2319

Provider Business Practice Location Address
First Line	:	1628 E BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2515
Country	:	US
Telephone Number	:	602-230-9292
Fax Number	:	602-230-2319

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ROBERT DAVID WELCH III
Credential	:	D.C.
Telephone Number	:	602-230-9292

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	07/24/2012

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