MEDICARE: BISH CHIROPRACTIC L.L.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	DCOO5763	PA

General Provider Information

NPI Number	:	1114216066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISH CHIROPRACTIC L.L.C

Provider Business Mailing Address
First Line	:	363 BROAD ST
Second Line	:	SUITE 1
City	:	NEW BETHLEHEM
State	:	PA
Zip	:	16242-1304
Country	:	US
Telephone Number	:	814-275-4030
Fax Number	:	814-275-4483

Provider Business Practice Location Address
First Line	:	363 BROAD ST
Second Line	:	SUITE 1
City	:	NEW BETHLEHEM
State	:	PA
Zip	:	16242-1304
Country	:	US
Telephone Number	:	814-275-4030
Fax Number	:	814-275-4483

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH TODD BISH
Credential	:	D.C.
Telephone Number	:	814-275-4030

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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