MEDICARE: ADVANCED CHIROPRACTIC SYSTEMS LLC

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	DC008926	PA
2	111NN1001X	Nutrition Chiropractor	DC006974-2	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1775454	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1346252004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC SYSTEMS LLC

Provider Business Mailing Address
First Line	:	113 7TH ST
Second Line	:	LUMBERYARD SHOPS
City	:	MILFORD
State	:	PA
Zip	:	18337-1234
Country	:	US
Telephone Number	:	570-409-9500
Fax Number	:	570-409-9505

Provider Business Practice Location Address
First Line	:	113 7TH ST
Second Line	:	LUMBERYARD SHOPS
City	:	MILFORD
State	:	PA
Zip	:	18337-1234
Country	:	US
Telephone Number	:	570-409-9500
Fax Number	:	570-409-9505

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. DEBORAH MARIE CASSIDY
Credential	:	D.C.
Telephone Number	:	570-409-9500

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/07/2008

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Directions to “ADVANCED CHIROPRACTIC SYSTEMS LLC ” Practice Location

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