MEDICARE: ARLINGTON CHIROPRACTIC CLINIC, INC.

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	976	OH

General Provider Information

NPI Number	:	1740319979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARLINGTON CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	1875 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1869
Country	:	US
Telephone Number	:	614-451-0472
Fax Number	:	614-451-0882

Provider Business Practice Location Address
First Line	:	1875 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1869
Country	:	US
Telephone Number	:	614-451-0472
Fax Number	:	614-451-0882

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. STEPHEN R PETTAY
Credential	:	DC
Telephone Number	:	614-451-0472

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	10/03/2011

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