MEDICARE: ADIO FAMILY CHIROPRACTIC, LLC

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	006811	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386868487	OTHER	MO	NPI

General Provider Information

NPI Number	:	1649542341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADIO FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	2330 HWY 94 S OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:	636-498-2346
Fax Number	:	636-498-2727

Provider Business Practice Location Address
First Line	:	2330 HWY 94 S OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:	636-498-2346
Fax Number	:	636-498-2727

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID WALLACE
Credential	:	D.C.
Telephone Number	:	636-498-2346

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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