MEDICARE: WEST SALEM CHIROPRACTIC CLINIC, 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	261QH0100X	Health Service Clinic/Center	3409-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477727931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SALEM CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	640 COMMERCE ST
Second Line	:
City	:	WEST SALEM
State	:	WI
Zip	:	54669-1179
Country	:	US
Telephone Number	:	608-786-3304
Fax Number	:	608-786-4574

Provider Business Practice Location Address
First Line	:	640 COMMERCE ST
Second Line	:
City	:	WEST SALEM
State	:	WI
Zip	:	54669-1179
Country	:	US
Telephone Number	:	608-786-3304
Fax Number	:	608-786-4574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL JOSEPH EORIATTI
Credential	:	D.C.
Telephone Number	:	608-786-3304

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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