MEDICARE: AGC STRUCTURAL SHIFT INC.

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	2457	AL

General Provider Information

NPI Number	:	1851826317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGC STRUCTURAL SHIFT INC.

Provider Business Mailing Address
First Line	:	4851 CAHABA RIVER RD STE 103
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4851 CAHABA RIVER RD STE 103
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2359
Country	:	US
Telephone Number	:	205-206-9341
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARTHUR G CHOW
Credential	:	D.C.
Telephone Number	:	662-832-3859

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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