MEDICARE: EXCELL SPORTS CHIROPRACTIC & REHAB, 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	261Q00000X	Clinic/Center	08002244A	IN

General Provider Information

NPI Number	:	1477845220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELL SPORTS CHIROPRACTIC & REHAB, LLC

Provider Business Mailing Address
First Line	:	8660 GUION RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3011
Country	:	US
Telephone Number	:	317-429-9031
Fax Number	:	317-388-8002

Provider Business Practice Location Address
First Line	:	8660 GUION RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3011
Country	:	US
Telephone Number	:	317-429-9031
Fax Number	:	317-388-8002

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARCUS MCCRAY
Credential	:	DC
Telephone Number	:	317-429-9031

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/24/2011

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