MEDICARE: PRINCIPLED PHYSICIANS & REHABILITATION CENTER OF HAMILTON

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	2006	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558315978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCIPLED PHYSICIANS & REHABILITATION CENTER OF HAMILTON

Provider Business Mailing Address
First Line	:	4083 PLEASANT AVE
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45015-1907
Country	:	US
Telephone Number	:	513-887-9400
Fax Number	:	513-887-7512

Provider Business Practice Location Address
First Line	:	4083 PLEASANT AVE
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45015-1907
Country	:	US
Telephone Number	:	513-887-9400
Fax Number	:	513-887-7512

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES M POPA III
Credential	:	DC
Telephone Number	:	513-887-9400

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	11/21/2007

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