MEDICARE: COLEMAN CHIROPRACTIC, PC

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	006684	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133659	OTHER	MO	BLUE CROSS GROUP PIN

General Provider Information

NPI Number	:	1508196338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEMAN CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	605 N COMMERCIAL AVE
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1103
Country	:	US
Telephone Number	:	636-629-2414
Fax Number	:	636-629-2406

Provider Business Practice Location Address
First Line	:	605 N COMMERCIAL AVE
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1103
Country	:	US
Telephone Number	:	636-629-2414
Fax Number	:	636-629-2406

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARTON J COLEMAN
Credential	:	DC
Telephone Number	:	636-629-2414

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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