MEDICARE: ADVANCED RELIEF CHIROPRACTIC

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	4191	OK

General Provider Information

NPI Number	:	1386024248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED RELIEF CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2408 SE 92ND TER
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-6098
Country	:	US
Telephone Number	:	904-955-7237
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020-B N. MAY AVE.
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-822-4476
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ELLICIA CLAIRE KAISER
Credential	:
Telephone Number	:	904-955-7237

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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