MEDICARE: ALCOTT BLUE WATER CHIROPRACTIC, INC.

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	2301005848	MI

General Provider Information

NPI Number	:	1124294236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALCOTT BLUE WATER CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	3941 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4102
Country	:	US
Telephone Number	:	810-985-6868
Fax Number	:	810-985-6991

Provider Business Practice Location Address
First Line	:	3941 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4102
Country	:	US
Telephone Number	:	810-985-6868
Fax Number	:	810-985-6991

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT DOUGLAS ALCOTT
Credential	:	D.C.
Telephone Number	:	810-985-6868

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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