MEDICARE: LEVINE CHIROPRACTIC CENTER, LLC

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	00851	CT

General Provider Information

NPI Number	:	1750580650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVINE CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	24 CHURCH ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-0000
Country	:	US
Telephone Number	:	860-489-3663
Fax Number	:	860-489-3738

Provider Business Practice Location Address
First Line	:	24 CHURCH ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-0000
Country	:	US
Telephone Number	:	860-489-3663
Fax Number	:	860-489-3738

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK R LEVINE
Credential	:	D.C.
Telephone Number	:	860-489-3663

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	06/03/2011

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