MEDICARE: CAPITAL CHIROPRACTIC CENTER 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

General Provider Information

NPI Number	:	1659984912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	3201 SKIPWITH RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4442
Country	:	US
Telephone Number	:	804-282-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 SKIPWITH RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4442
Country	:	US
Telephone Number	:	804-282-0403
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	ANDREW MELCHERT
Credential	:	DC
Telephone Number	:	804-282-0403

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	08/26/2020

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