MEDICARE: CANAL CHIROPRACTIC AND REHAB 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	111N00000X	Chiropractor	1955	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	:	1598767212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANAL CHIROPRACTIC AND REHAB INC

Provider Business Mailing Address
First Line	:	6790 THRUSH DR
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-8385
Country	:	US
Telephone Number	:	614-833-0563
Fax Number	:	614-833-0916

Provider Business Practice Location Address
First Line	:	6790 THRUSH DR
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-8385
Country	:	US
Telephone Number	:	614-833-0563
Fax Number	:	614-833-0916

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT BARRY WADE
Credential	:	D.C.
Telephone Number	:	614-833-0563

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/28/2008

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Directions to “CANAL CHIROPRACTIC AND REHAB INC ” Practice Location

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