MEDICARE: FLETCHER 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	DC25138	CA

General Provider Information

NPI Number	:	1194819953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLETCHER CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	1227 LINCOLN AVENUE
Second Line	:	SUITE B
City	:	CALISTOGA
State	:	CA
Zip	:	94515
Country	:	US
Telephone Number	:	707-942-9592
Fax Number	:	707-942-9593

Provider Business Practice Location Address
First Line	:	1227 LINCOLN AVENUE
Second Line	:	SUITE B
City	:	CALISTOGA
State	:	CA
Zip	:	94515
Country	:	US
Telephone Number	:	707-942-9592
Fax Number	:	707-942-9593

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN PAUL FLETCHER
Credential	:	D.C.
Telephone Number	:	707-942-9592

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/03/2008

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