MEDICARE: HANK DEPOLO CORP

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	CH3543	FL

General Provider Information

NPI Number	:	1174712665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANK DEPOLO CORP

Provider Business Mailing Address
First Line	:	2160 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3740
Country	:	US
Telephone Number	:	863-648-2006
Fax Number	:	863-648-2393

Provider Business Practice Location Address
First Line	:	2160 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3740
Country	:	US
Telephone Number	:	863-648-2006
Fax Number	:	863-648-2393

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. HANK DE POLO
Credential	:	D.C.
Telephone Number	:	863-648-2006

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	12/14/2007

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Directions to “HANK DEPOLO CORP ” Practice Location

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