MEDICARE: FOUNTAIN MILLS CHIROPRACTIC, 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	111NR0400X	Rehabilitation Chiropractor	DC009392	PA

General Provider Information

NPI Number	:	1356535504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN MILLS CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	17 N CHESTNUT ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1714
Country	:	US
Telephone Number	:	724-887-7269
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 N CHESTNUT ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1714
Country	:	US
Telephone Number	:	724-887-7269
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR/PRESIDENT
Name	:	DR. MICHAEL JON PAGLIACCI
Credential	:	D.C.
Telephone Number	:	724-887-7269

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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