MEDICARE: HILLSIDE CHIROPRACTIC CLINIC

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	3678	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03D80HI	OTHER		BCBS

General Provider Information

NPI Number	:	1679764690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSIDE CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	19449 EVANS ST NW
Second Line	:	SUITE A
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19449 EVANS ST NW
Second Line	:	SUITE A
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1074
Country	:	US
Telephone Number	:	763-241-5393
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY PAUL SCHNEIDER
Credential	:
Telephone Number	:	763-241-5393

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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Directions to “HILLSIDE CHIROPRACTIC CLINIC ” Practice Location

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