MEDICARE: DR. TINA KATHLEEN ST. JOHN 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	3246	OH

General Provider Information

NPI Number	:	1184831851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA KATHLEEN ST. JOHN D.C.

Provider Business Mailing Address
First Line	:	8573 TANGLEWOOD TRL
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-5635
Country	:	US
Telephone Number	:	440-543-6637
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 N MAIN ST
Second Line	:	SUITE 206
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3016
Country	:	US
Telephone Number	:	440-893-0348
Fax Number	:	440-893-0354

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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