MEDICARE: ST. JOHNS CHIROPRACTIC CLINIC, INC.

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

General Provider Information

NPI Number	:	1285819169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHNS CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	1004 N US HIGHWAY 27
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-1129
Country	:	US
Telephone Number	:	989-224-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 N US HIGHWAY 27
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-1129
Country	:	US
Telephone Number	:	989-224-8228
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODGER W MASSA
Credential	:
Telephone Number	:	989-224-8228

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	04/09/2008

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