MEDICARE: DR. JUSTIN MICHAEL HOFFMAN D.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	2013001703	MO
2	111NR0400X	Rehabilitation Chiropractor	2013001703	MO
3	111NX0800X	Orthopedic Chiropractor	2013001703	MO
4	111NN1001X	Nutrition Chiropractor	2013001703	MO

General Provider Information

NPI Number	:	1437491636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN MICHAEL HOFFMAN D.C.

Provider Business Mailing Address
First Line	:	355 MID RIVERS MALL DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1593
Country	:	US
Telephone Number	:	636-970-0155
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 MID RIVERS MALL DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1593
Country	:	US
Telephone Number	:	636-970-0155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	05/06/2013

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