MEDICARE: WHITE RIVER CHIROPRACTIC LIFE CENTER, 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	940	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5F871	OTHER	AR	MEDICARE PTAN (LEGACY NUMBER)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770709321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE RIVER CHIROPRACTIC LIFE CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2544
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72503-2544
Country	:	US
Telephone Number	:	870-698-1650
Fax Number	:	870-793-4790

Provider Business Practice Location Address
First Line	:	1361 WHITE DR
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-9467
Country	:	US
Telephone Number	:	870-698-1650
Fax Number	:	870-793-4790

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS DEAN TAYLOR
Credential	:	D.C.
Telephone Number	:	870-698-1650

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	06/30/2008

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Directions to “WHITE RIVER CHIROPRACTIC LIFE CENTER, INC. ” Practice Location

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