MEDICARE: FIRST CHOICE CHIROPRACTIC, LLC

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	0104556700	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225260011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1770 N PARHAM RD
Second Line	:	SUITE 103
City	:	RICHMOND
State	:	VA
Zip	:	23229-4658
Country	:	US
Telephone Number	:	804-592-9862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 N PARHAM RD
Second Line	:	SUITE 103
City	:	RICHMOND
State	:	VA
Zip	:	23229-4658
Country	:	US
Telephone Number	:	804-592-9862
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	MR. ANDREW WALTER GESKIE
Credential	:	D.C.
Telephone Number	:	804-592-9862

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	08/13/2009

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