MEDICARE: ORTHO CHIROPRACTIC P.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

General Provider Information

NPI Number	:	1629213293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	2540 E THOMAS RD
Second Line	:	SUITE H
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7947
Country	:	US
Telephone Number	:	602-522-2772
Fax Number	:	602-522-2774

Provider Business Practice Location Address
First Line	:	2540 E THOMAS RD
Second Line	:	SUITE H
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7947
Country	:	US
Telephone Number	:	602-522-2772
Fax Number	:	602-522-2774

Authorized Official
Title or Position	:	OWNER
Name	:	ANDY SBILIRIS
Credential	:	D.C.
Telephone Number	:	602-522-2772

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	01/12/2009

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