MEDICARE: FIRST CHIROPRACTIC ST. MARY'S LLC

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

General Provider Information

NPI Number	:	1437194537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHIROPRACTIC ST. MARY'S LLC

Provider Business Mailing Address
First Line	:	1325 W SAINT MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-3112
Country	:	US
Telephone Number	:	520-624-8105
Fax Number	:	520-624-4422

Provider Business Practice Location Address
First Line	:	1325 W SAINT MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-3112
Country	:	US
Telephone Number	:	520-624-8105
Fax Number	:	520-624-4422

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. ROBIN DONALD O'NEAL
Credential	:	DC
Telephone Number	:	520-886-4213

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	01/10/2008

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