MEDICARE: TRI-STATE CHIROPRACTIC

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	08002459A	IN

General Provider Information

NPI Number	:	1841381654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2014 N WAYNE ST
Second Line	:
City	:	ANGOLA
State	:	IN
Zip	:	46703-9102
Country	:	US
Telephone Number	:	260-665-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 N WAYNE ST
Second Line	:
City	:	ANGOLA
State	:	IN
Zip	:	46703-9102
Country	:	US
Telephone Number	:	260-665-3106
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ROBERT SLUSARSKI
Credential	:	D.C.
Telephone Number	:	517-416-7478

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/12/2010

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Directions to “TRI-STATE CHIROPRACTIC ” Practice Location

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