MEDICARE: DR. MARTIN ALAN WOLCHANSKY 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	005628	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113082	OTHER	MO	GHP
2	287276	OTHER	MO	HEALTH LINK
3	4668022	OTHER	MO	AETNA
4	14212	OTHER	MO	BLUECROSSBLUESHIELD
5	44-00199	OTHER	MO	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1073627444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN ALAN WOLCHANSKY D.C.

Provider Business Mailing Address
First Line	:	11935 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6729
Country	:	US
Telephone Number	:	314-432-0005
Fax Number	:	314-432-5899

Provider Business Practice Location Address
First Line	:	11935 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6729
Country	:	US
Telephone Number	:	314-432-0005
Fax Number	:	314-432-5899

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. MARTIN ALAN WOLCHANSKY D.C.” Practice Location

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