MEDICARE: TONY C SCARLASSARA 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	2301009353	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950C610130	OTHER		BCBSM
2	9474154	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1881875219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY C SCARLASSARA D.C.

Provider Business Mailing Address
First Line	:	615 W ADAMS ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1321
Country	:	US
Telephone Number	:	906-265-9000
Fax Number	:	906-265-9009

Provider Business Practice Location Address
First Line	:	615 W ADAMS ST
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1321
Country	:	US
Telephone Number	:	906-265-9000
Fax Number	:	906-265-9009

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

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	02/09/2011

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