MEDICARE: QUANTUMCARE CHIROPRACTIC PS

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	CH00002438	WA

General Provider Information

NPI Number	:	1760671176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUMCARE CHIROPRACTIC PS

Provider Business Mailing Address
First Line	:	3948B CLEVELAND AVE SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-4023
Country	:	US
Telephone Number	:	360-754-7500
Fax Number	:	360-754-7584

Provider Business Practice Location Address
First Line	:	3948B CLEVELAND AVE SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-4023
Country	:	US
Telephone Number	:	360-754-7500
Fax Number	:	360-754-7584

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. FRANK MATTHEW RUSSELL
Credential	:	D.C.
Telephone Number	:	360-754-7500

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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