MEDICARE: QUALITY CHIROPRACTIC CENTER PLLC

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	CHIA1505	ID
2	111N00000X	Chiropractor	CHIA1041	ID

General Provider Information

NPI Number	:	1487900205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY CHIROPRACTIC CENTER PLLC

Provider Business Mailing Address
First Line	:	619 S WASHINGTON ST STE 101
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-3063
Country	:	US
Telephone Number	:	208-883-4300
Fax Number	:	208-883-4311

Provider Business Practice Location Address
First Line	:	619 S WASHINGTON ST STE 101
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-3063
Country	:	US
Telephone Number	:	208-883-4300
Fax Number	:	208-883-4311

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. JAMES E MCKENZIE
Credential	:	D.C.
Telephone Number	:	208-883-4300

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	09/18/2013

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