MEDICARE: CHIROPRACTIC MANAGEMENT SERVICES, 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	271620	OR

General Provider Information

NPI Number	:	1457358400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC MANAGEMENT SERVICES, P.C.

Provider Business Mailing Address
First Line	:	1819 14TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-8502
Country	:	US
Telephone Number	:	541-928-1010
Fax Number	:	541-928-1093

Provider Business Practice Location Address
First Line	:	1819 14TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-8502
Country	:	US
Telephone Number	:	541-928-1010
Fax Number	:	541-928-1093

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANK T HERESCO
Credential	:	D.C.
Telephone Number	:	541-757-9933

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	01/30/2013

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