MEDICARE: NEW BOSTON CHIROPRACTIC LIFE CENTER, CORPORATION

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	2301008358	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P11040001	OTHER	MI	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-0D60102-0	OTHER	MI	BLUE CROSS GROUP

General Provider Information

NPI Number	:	1811196272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BOSTON CHIROPRACTIC LIFE CENTER, CORPORATION

Provider Business Mailing Address
First Line	:	405 E CHICAGO BLVD
Second Line	:
City	:	TECUMSEH
State	:	MI
Zip	:	49286-1513
Country	:	US
Telephone Number	:	517-423-2639
Fax Number	:	517-423-0639

Provider Business Practice Location Address
First Line	:	405 E CHICAGO BLVD
Second Line	:
City	:	TECUMSEH
State	:	MI
Zip	:	49286-1513
Country	:	US
Telephone Number	:	517-423-2639
Fax Number	:	517-423-0639

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC/ PRESIDENT
Name	:	DR. GREGORY KIM MCFARLAND JR.
Credential	:	D.C.
Telephone Number	:	517-423-2639

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	03/14/2012

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Directions to “NEW BOSTON CHIROPRACTIC LIFE CENTER, CORPORATION ” Practice Location

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