Sample chiropractic receipt image

Sample chiropractic receipt image

  1. Chiropractor's name/clinic name and address 
  2. Date(s) of treatment 
  3. Full name of patient (no nicknames) 
  4. Complete diagnosis code(s) 
  5. Current Procedural Terminology (CPT) code and complete description of service 
  6. Individual charge for each treatment 
  7. Chiropractor's degree title 
  8. Chiropractor’s identification number (PIN) 
  9. Tax ID number if chiropractor is out-of-state