MEDICARE: BART V RHOADS 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	CE005898	MO
2	111N00000X	Chiropractor	5478	TX

General Provider Information

NPI Number	:	1811993157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BART V RHOADS D.C.

Provider Business Mailing Address
First Line	:	915 SOUTHWEST BLVD
Second Line	:	STE H
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-5014
Country	:	US
Telephone Number	:	573-636-9977
Fax Number	:	573-636-2209

Provider Business Practice Location Address
First Line	:	915 SOUTHWEST BLVD
Second Line	:	STE H
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-5014
Country	:	US
Telephone Number	:	573-636-9977
Fax Number	:	573-636-2209

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/09/2007

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