MEDICARE: JLW 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	5514	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z144435	OTHER	AZ	MEDICARE PTAN

General Provider Information

NPI Number	:	1417255209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLW CHIROPRACTIC

Provider Business Mailing Address
First Line	:	9420 W BELL RD
Second Line	:	SUITE 105
City	:	SUN CITY
State	:	AZ
Zip	:	85351-1362
Country	:	US
Telephone Number	:	623-815-1800
Fax Number	:	623-815-0500

Provider Business Practice Location Address
First Line	:	9420 W BELL RD
Second Line	:	SUITE 105
City	:	SUN CITY
State	:	AZ
Zip	:	85351-1362
Country	:	US
Telephone Number	:	623-815-1800
Fax Number	:	623-815-0500

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES L WARLICK
Credential	:	D.C.
Telephone Number	:	623-815-1800

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	01/05/2012

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Directions to “JLW CHIROPRACTIC ” Practice Location

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