MEDICARE: MINDY A WEINGARTEN D. C.

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	CHOOO4680	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00118022	OTHER	FL	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	22122	OTHER	FL	BC/BS PROVIDER NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164426581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY A WEINGARTEN D. C.

Provider Business Mailing Address
First Line	:	4606 S CLYDE MORRIS BLVD
Second Line	:	STE 1M
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-7453
Country	:	US
Telephone Number	:	386-756-9303
Fax Number	:	386-756-8119

Provider Business Practice Location Address
First Line	:	4606 S CLYDE MORRIS BLVD
Second Line	:	STE 1M
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-7453
Country	:	US
Telephone Number	:	386-756-9303
Fax Number	:	386-756-8119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/09/2012

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Directions to “ MINDY A WEINGARTEN D. C.” Practice Location

Language	Start Address	Practice Location

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