MEDICARE: TAWAS CHIROPRACTIC CENTER, INC

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	2301007232	MI

General Provider Information

NPI Number	:	1407112816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAWAS CHIROPRACTIC CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 207
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48764-0207
Country	:	US
Telephone Number	:	989-362-9910
Fax Number	:	989-362-8198

Provider Business Practice Location Address
First Line	:	1113 W LAKE ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9304
Country	:	US
Telephone Number	:	989-362-9910
Fax Number	:	989-362-8198

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RENEE D BIRD
Credential	:
Telephone Number	:	989-362-9910

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	04/10/2012

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