MEDICARE: DR. PAUL HYLAND 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	2005013007	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201465	OTHER	MO	BCBS
2	681081	OTHER	MO	ACN
3	1061750-00	OTHER	MO	ASH

General Provider Information

NPI Number	:	1154306066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL HYLAND D.C.

Provider Business Mailing Address
First Line	:	13035 OLIVE BLVD
Second Line	:	SUITE 216
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6173
Country	:	US
Telephone Number	:	314-542-2003
Fax Number	:	314-542-2007

Provider Business Practice Location Address
First Line	:	13035 OLIVE BLVD
Second Line	:	SUITE 216
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6173
Country	:	US
Telephone Number	:	314-542-2003
Fax Number	:	314-542-2007

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/02/2008

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