MEDICARE: POWELL CHIROPRACTIC CLINIC

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	3551	MO

General Provider Information

NPI Number	:	1225237837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWELL CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	604 S MAIN ST # 274
Second Line	:
City	:	ROCK PORT
State	:	MO
Zip	:	64482-1448
Country	:	US
Telephone Number	:	660-744-2032
Fax Number	:	660-744-2062

Provider Business Practice Location Address
First Line	:	604 S MAIN ST
Second Line	:
City	:	ROCK PORT
State	:	MO
Zip	:	64482-1448
Country	:	US
Telephone Number	:	660-744-2032
Fax Number	:	660-744-2062

Authorized Official
Title or Position	:	OWNER/ SOLE PROPRIETOR
Name	:	DR. GARY RODGER POWELL
Credential	:	D.C.
Telephone Number	:	660-744-2032

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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