MEDICARE: PROTZ CHIROPRACTIC WELLNESS CLINIC, LLC

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	1632	AL

General Provider Information

NPI Number	:	1821419318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTZ CHIROPRACTIC WELLNESS CLINIC, LLC

Provider Business Mailing Address
First Line	:	12815 US HIGHWAY 431
Second Line	:
City	:	SARDIS CITY
State	:	AL
Zip	:	35956-2046
Country	:	US
Telephone Number	:	256-593-3551
Fax Number	:	256-593-4603

Provider Business Practice Location Address
First Line	:	12815 US HIGHWAY 431
Second Line	:
City	:	SARDIS CITY
State	:	AL
Zip	:	35956-2046
Country	:	US
Telephone Number	:	256-593-3551
Fax Number	:	256-593-4603

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. PAUL ANDREW PROTZ JR.
Credential	:	D.C.
Telephone Number	:	256-593-3551

Provider Enumeration Date	:	12/30/2013
Last Update Date	:	12/30/2013

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