MEDICARE: DR. EDWARD CLARK BICKMEYER D.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	006118	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4668026	OTHER	MO	AETNA
2	239301	OTHER	MO	HEALTHLINK
3	4728	OTHER	MO	ANTHEM
4	81635	OTHER	MO	GROUP HEALTH PLAN

General Provider Information

NPI Number	:	1699788810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CLARK BICKMEYER D.C.

Provider Business Mailing Address
First Line	:	1362 S 5TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2444
Country	:	US
Telephone Number	:	636-947-7463
Fax Number	:

Provider Business Practice Location Address
First Line	:	1362 S 5TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2444
Country	:	US
Telephone Number	:	636-947-7463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/09/2007

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