MEDICARE: BODY FIRST 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	DC009747	PA

General Provider Information

NPI Number	:	1992947931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY FIRST CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1913 E PLEASANT VALLEY BLVD
Second Line	:	SUITE #2
City	:	ALTOONA
State	:	PA
Zip	:	16602-7509
Country	:	US
Telephone Number	:	814-942-2304
Fax Number	:	814-942-8004

Provider Business Practice Location Address
First Line	:	1913 E PLEASANT VALLEY BLVD
Second Line	:	SUITE #2
City	:	ALTOONA
State	:	PA
Zip	:	16602-7509
Country	:	US
Telephone Number	:	814-942-2304
Fax Number	:	814-942-8004

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER DAVID RIDDLE
Credential	:	D.C.
Telephone Number	:	814-942-2304

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	06/19/2009

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Directions to “BODY FIRST CHIROPRACTIC LLC ” Practice Location

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