MEDICARE: BRETT TYSON POLING D.C.

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	01-04771	KS

General Provider Information

NPI Number	:	1780781757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT TYSON POLING D.C.

Provider Business Mailing Address
First Line	:	PO BOX 166
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-0166
Country	:	US
Telephone Number	:	785-332-3105
Fax Number	:	785-332-3188

Provider Business Practice Location Address
First Line	:	709 S BENTON ST
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-3508
Country	:	US
Telephone Number	:	785-332-3105
Fax Number	:	785-332-3188

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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