MEDICARE: DR. BENNY CLEVE TROWBRIDGE 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	2944	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G7090	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1942237557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENNY CLEVE TROWBRIDGE D.C.

Provider Business Mailing Address
First Line	:	2112 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3815
Country	:	US
Telephone Number	:	325-942-7661
Fax Number	:	325-942-0116

Provider Business Practice Location Address
First Line	:	2112 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3815
Country	:	US
Telephone Number	:	325-942-7661
Fax Number	:	325-942-0116

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/09/2007

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