MEDICARE: EVOLUTION CHIROPRACTIC P.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	:	1699099259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLUTION CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	PO BOX 593
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-0209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 PUGSLEY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4408
Country	:	US
Telephone Number	:	718-239-9119
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL V. SCARBOROUGH JR.
Credential	:
Telephone Number	:	646-358-5608

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/25/2010

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Language	Start Address	Practice Location

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