MEDICARE: TOTAL HEALTH CHIROPRACTIC, 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	CHIA-988	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C3530	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1386831931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL HEALTH CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	285 E 4TH N
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2716
Country	:	US
Telephone Number	:	208-587-3345
Fax Number	:	208-587-7473

Provider Business Practice Location Address
First Line	:	285 E 4TH N
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2716
Country	:	US
Telephone Number	:	208-587-3345
Fax Number	:	208-587-7473

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLIFTON C. ANDREWS
Credential	:	D.C.
Telephone Number	:	208-587-3345

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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