MEDICARE: FRANKLIN COUNTY CHIROPRACTIC CLINIC, 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	111NS0005X	Sports Physician Chiropractor	08007533	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972676435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANKLIN COUNTY CHIROPRACTIC CLINIC, INC

Provider Business Mailing Address
First Line	:	1235 FRANKLIN AVE
Second Line	:	P O BOX 387
City	:	BROOKVILLE
State	:	IN
Zip	:	47012-1037
Country	:	US
Telephone Number	:	765-647-5332
Fax Number	:	765-647-5332

Provider Business Practice Location Address
First Line	:	1235 FRANKLIN AVE
Second Line	:
City	:	BROOKVILLE
State	:	IN
Zip	:	47012-1037
Country	:	US
Telephone Number	:	765-647-5332
Fax Number	:	765-647-5332

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL PAUL BUKOFCHAN
Credential	:	D.C.
Telephone Number	:	765-647-5332

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	01/21/2015

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