MEDICARE: DR. BARRY SCOTT PEDICORD 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	454	OH

General Provider Information

NPI Number	:	1356485858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY SCOTT PEDICORD D.C.

Provider Business Mailing Address
First Line	:	3625 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45420-2438
Country	:	US
Telephone Number	:	937-252-1671
Fax Number	:	937-252-7717

Provider Business Practice Location Address
First Line	:	3625 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45420-2438
Country	:	US
Telephone Number	:	937-252-1671
Fax Number	:	937-252-7717

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	09/30/2011

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