MEDICARE: PROFICIENT CHIROPRACTIC LLC

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	2006022760	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200250	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1124194428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFICIENT CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2050 WOODSON RD
Second Line	:	STE #101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5644
Country	:	US
Telephone Number	:	314-713-1656
Fax Number	:	314-395-0607

Provider Business Practice Location Address
First Line	:	2050 WOODSON RD
Second Line	:	STE #101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5644
Country	:	US
Telephone Number	:	314-713-1656
Fax Number	:	314-395-0607

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. EDGAR EVERETT III
Credential	:	D.C
Telephone Number	:	314-713-1656

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/09/2008

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