MEDICARE: MASON CITY CHIROPRACTIC, INC.

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	111NX0800X	Orthopedic Chiropractor	06519	IA

General Provider Information

NPI Number	:	1588855068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASON CITY CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1314 4TH ST SW STE 112
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2758
Country	:	US
Telephone Number	:	641-424-0992
Fax Number	:	641-424-0200

Provider Business Practice Location Address
First Line	:	1314 4TH ST SW STE 112
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2758
Country	:	US
Telephone Number	:	641-424-0992
Fax Number	:	641-424-0200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT W NELSON
Credential	:	D.C.
Telephone Number	:	641-424-0992

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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