MEDICARE: BLACKWELL CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225700000X	Massage Therapist
2	225X00000X	Occupational Therapist
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1548622442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKWELL CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	6039 SHERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6402
Country	:	US
Telephone Number	:	214-363-5267
Fax Number	:	214-361-1656

Provider Business Practice Location Address
First Line	:	6039 SHERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6402
Country	:	US
Telephone Number	:	214-363-5267
Fax Number	:	214-361-1656

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELVIN DALTON BLACKWELL
Credential	:	D.C.
Telephone Number	:	214-363-5267

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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