MEDICARE: TCR CHIROPRACTIC AND WELLNESS, 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

General Provider Information

NPI Number	:	1871448035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCR CHIROPRACTIC AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	625 PARKVIEW DR STE 103
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-4204
Country	:	US
Telephone Number	:	815-474-8627
Fax Number	:	815-474-8627

Provider Business Practice Location Address
First Line	:	625 PARKVIEW DR STE 103
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-4204
Country	:	US
Telephone Number	:	815-474-8627
Fax Number	:	815-474-8627

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	ROBERT B DEEVERS
Credential	:	DEEVERS
Telephone Number	:	815-474-8627

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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