MEDICARE: CHIROPLUS NORTH PC

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	:	1053746313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPLUS NORTH PC

Provider Business Mailing Address
First Line	:	PO BOX 48370
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76148-0370
Country	:	US
Telephone Number	:	817-498-7333
Fax Number	:	817-581-2866

Provider Business Practice Location Address
First Line	:	3625 WESTERN CENTER BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-1936
Country	:	US
Telephone Number	:	817-498-7333
Fax Number	:	817-581-2866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GIDEON TRAWEEK
Credential	:	D.C.
Telephone Number	:	817-498-7333

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/05/2013

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Directions to “CHIROPLUS NORTH PC ” Practice Location

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