MEDICARE: 100 CHIRO ROSADO PT ORANGE PLLC

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

General Provider Information

NPI Number	:	1144095605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	100 CHIRO ROSADO PT ORANGE PLLC

Provider Business Mailing Address
First Line	:	5517 S WILLIAMSON BLVD STE 305
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-8310
Country	:	US
Telephone Number	:	386-444-7700
Fax Number	:	386-444-7070

Provider Business Practice Location Address
First Line	:	5517 S WILLIAMSON BLVD STE 305
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-8310
Country	:	US
Telephone Number	:	386-444-7700
Fax Number	:	386-444-7070

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PEDRO ROSADO
Credential	:
Telephone Number	:	813-495-4181

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	06/24/2024

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