MEDICARE: FAMILY TREE CHIROPRACTIC MT JOY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111NP0017X	Pediatric Chiropractor
2	111NR0200X	Radiology Chiropractor
3	111NS0005X	Sports Physician Chiropractor
4	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1194027615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TREE CHIROPRACTIC MT JOY LLC

Provider Business Mailing Address
First Line	:	1013 W MAIN ST STE 1
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-9699
Country	:	US
Telephone Number	:	717-808-4484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 W MAIN ST STE 1
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-9699
Country	:	US
Telephone Number	:	717-808-4484
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BENJAMIN S BRYSON
Credential	:	CSA, CLTC, CPL
Telephone Number	:	717-808-4484

Provider Enumeration Date	:	12/03/2010
Last Update Date	:	12/03/2010

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