MEDICARE: CHIROPRACTIC ASSOCIATES, P.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	5608	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	607052	OTHER	TX	BLUE CROSS/BLUE SHIELD
2	U09756	OTHER	TX	UPIN

General Provider Information

NPI Number	:	1366613168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	212 GULF FWY S
Second Line	:	SUITE G-1
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3956
Country	:	US
Telephone Number	:	281-332-6816
Fax Number	:	281-338-9998

Provider Business Practice Location Address
First Line	:	212 GULF FWY S
Second Line	:	SUITE G-1
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3956
Country	:	US
Telephone Number	:	281-332-6816
Fax Number	:	281-338-9998

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. JOHN M VACLAVIK
Credential	:	DC
Telephone Number	:	281-332-6816

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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