MEDICARE: DOCTOR'S BAG, P.A.

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	CH 8305	FL

General Provider Information

NPI Number	:	1003099219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTOR'S BAG, P.A.

Provider Business Mailing Address
First Line	:	137 PENNSYLVANIA AVE
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-3434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5646
Country	:	US
Telephone Number	:	727-787-5717
Fax Number	:	727-787-5720

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	DR. GORDON B LOVETT
Credential	:	D.C.
Telephone Number	:	727-787-5717

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	08/21/2009

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