MEDICARE: DR. SHAINE EMANUEL RIDER D.C.

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	1216	LA

General Provider Information

NPI Number	:	1568560217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAINE EMANUEL RIDER D.C.

Provider Business Mailing Address
First Line	:	4451 NELSON RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4136
Country	:	US
Telephone Number	:	337-480-0027
Fax Number	:	337-480-0499

Provider Business Practice Location Address
First Line	:	4451 NELSON RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4136
Country	:	US
Telephone Number	:	337-480-0027
Fax Number	:	337-480-0499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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