MEDICARE: AUSTIN PANTER 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	2014013288	MO

General Provider Information

NPI Number	:	1255742011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN PANTER D.C

Provider Business Mailing Address
First Line	:	40 WALTER CT
Second Line	:
City	:	MOSCOW MILLS
State	:	MO
Zip	:	63362-1197
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 WALTER CT
Second Line	:
City	:	MOSCOW MILLS
State	:	MO
Zip	:	63362-1197
Country	:	US
Telephone Number	:	636-356-5557
Fax Number	:

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

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	05/14/2014

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