MEDICARE: THE CHIROPRACTIC PLACE, P.A.

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	11690	TX

General Provider Information

NPI Number	:	1689959496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHIROPRACTIC PLACE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 64
Second Line	:
City	:	SANTO
State	:	TX
Zip	:	76472-0064
Country	:	US
Telephone Number	:	682-214-0408
Fax Number	:	817-441-2811

Provider Business Practice Location Address
First Line	:	213 OLD ANNETTA RD
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-4455
Country	:	US
Telephone Number	:	682-214-0408
Fax Number	:	817-441-2811

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHELLE PARKER
Credential	:	D.C.
Telephone Number	:	682-214-0408

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	05/20/2014

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Directions to “THE CHIROPRACTIC PLACE, P.A. ” Practice Location

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