MEDICARE: DELTA SPECIFIS CHIROPRACTIC, L.L.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	:	1659307114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA SPECIFIS CHIROPRACTIC, L.L.C.

Provider Business Mailing Address
First Line	:	8403 MARYLAND AVE
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8403 MARYLAND AVE
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3646
Country	:	US
Telephone Number	:	314-725-3358
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHISTOPHER MAFFITT
Credential	:	DC
Telephone Number	:	314-725-3358

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	07/11/2008

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