MEDICARE: PORTER CHIROPRACTIC AND WELLNESS, 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	261QM2500X	Medical Specialty Clinic/Center	CH10961	FL

General Provider Information

NPI Number	:	1114350097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER CHIROPRACTIC AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1367 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-316-2524
Fax Number	:	386-310-8770

Provider Business Practice Location Address
First Line	:	1367 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-317-2000
Fax Number	:	386-265-5552

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN/OWNER
Name	:	DR. DEBORA LYNN PORTER
Credential	:	D.C.
Telephone Number	:	386-316-2524

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	05/06/2020

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