MEDICARE: PA CHIROPRACTIC CLINIC, 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	2190	AL

General Provider Information

NPI Number	:	1528236171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PA CHIROPRACTIC CLINIC, LLC

Provider Business Mailing Address
First Line	:	1951 GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3417
Country	:	US
Telephone Number	:	256-845-0528
Fax Number	:	256-845-5123

Provider Business Practice Location Address
First Line	:	1951 GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3417
Country	:	US
Telephone Number	:	256-845-0528
Fax Number	:	256-845-5123

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTA LILLIEANN CURTIS
Credential	:	DC
Telephone Number	:	256-845-0528

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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