MEDICARE: CLINE CHIROPRACTIC REHABILITATION CENTER 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	111N00000X	Chiropractor	3494	OR

General Provider Information

NPI Number	:	1518138239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINE CHIROPRACTIC REHABILITATION CENTER LLC.

Provider Business Mailing Address
First Line	:	5010 GRANGE RD
Second Line	:	SUITE 103
City	:	ROSEBURG
State	:	OR
Zip	:	97470-5846
Country	:	US
Telephone Number	:	541-679-0741
Fax Number	:	541-679-0751

Provider Business Practice Location Address
First Line	:	5010 GRANGE RD
Second Line	:	SUITE 103
City	:	ROSEBURG
State	:	OR
Zip	:	97470-5846
Country	:	US
Telephone Number	:	541-679-0741
Fax Number	:	541-679-0751

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. NICHOLAS DAVID CLINE
Credential	:	D.C.
Telephone Number	:	541-679-0741

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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