MEDICARE: ROOTS & WINGS CHIROPRACTIC, 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	:	1942897426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS & WINGS CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	311 ELM ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2736
Country	:	US
Telephone Number	:	513-207-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 ELM ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2736
Country	:	US
Telephone Number	:	513-207-8654
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	KATELYN ELIZABETH KRAFT
Credential	:	DC
Telephone Number	:	513-207-8654

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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