MEDICARE: 5-STAR CHIROPRACTIC SERVICES, 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	9236	NY

General Provider Information

NPI Number	:	1295075505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5-STAR CHIROPRACTIC SERVICES, PC

Provider Business Mailing Address
First Line	:	56 QUARRY LN
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 QUARRY LN
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1539
Country	:	US
Telephone Number	:	914-646-6893
Fax Number	:

Authorized Official
Title or Position	:	PRES/OWNER
Name	:	DR. ALLAN WATTENMAKER
Credential	:	DC
Telephone Number	:	914-646-6893

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	02/22/2013

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