MEDICARE: CYNTHIA M AIRHART D.C.

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	7155TX	TX

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
2	606244	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245258375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA M AIRHART D.C.

Provider Business Mailing Address
First Line	:	3506 SAM HOUSTON DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2233
Country	:	US
Telephone Number	:	361-579-9325
Fax Number	:	361-579-9328

Provider Business Practice Location Address
First Line	:	3506 SAM HOUSTON DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2233
Country	:	US
Telephone Number	:	361-579-9325
Fax Number	:	361-579-9328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/10/2012

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