MEDICARE: MICHAEL NOLL DC

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	DC003868L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	605575	OTHER	PA	BLUE SHIELD
2	50001131	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1750475208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NOLL DC

Provider Business Mailing Address
First Line	:	1931 PHILADELPHIA AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 PHILADELPHIA AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1435
Country	:	US
Telephone Number	:	717-267-1800
Fax Number	:	717-267-2990

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHAEL NOLL DC” Practice Location

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