MEDICARE: NORTHWOODS FAMILY CHIROPRACTIC PC

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	2301009466	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950C610120	OTHER	MI	BCBSMI

General Provider Information

NPI Number	:	1225285323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS FAMILY CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	615 W ADAMS ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1321
Country	:	US
Telephone Number	:	906-265-9000
Fax Number	:	906-265-9009

Provider Business Practice Location Address
First Line	:	615 W ADAMS ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1321
Country	:	US
Telephone Number	:	906-265-9000
Fax Number	:	906-265-9009

Authorized Official
Title or Position	:	CHIROPRACTOR/VICE PRESIDENT
Name	:	DR. KIMBERLY KAY SCARLASSARA
Credential	:	DC
Telephone Number	:	906-265-9000

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	01/28/2010

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