MEDICARE: DR. JOE DAVID TATE 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	DC5487	TX

General Provider Information

NPI Number	:	1063693687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE DAVID TATE D.C.

Provider Business Mailing Address
First Line	:	PO BOX 117
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-0117
Country	:	US
Telephone Number	:	940-433-2710
Fax Number	:	940-433-2710

Provider Business Practice Location Address
First Line	:	403 E ROCK ISLAND
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-3066
Country	:	US
Telephone Number	:	940-433-2710
Fax Number	:	940-433-2710

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

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	11/26/2007

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