MEDICARE: MESHBESHER CHIROPRACTIC CENTER PA

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	3173	MN

General Provider Information

NPI Number	:	1366516171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESHBESHER CHIROPRACTIC CENTER PA

Provider Business Mailing Address
First Line	:	2917 BRYANT AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2155
Country	:	US
Telephone Number	:	612-823-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2917 BRYANT AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2155
Country	:	US
Telephone Number	:	612-823-5456
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT DOCTOR OF CHIROPRACTIC
Name	:	DR. STACY J MESHBESHER
Credential	:	DC
Telephone Number	:	612-823-5456

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/07/2008

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