MEDICARE: DR. RUSSELL ANDREW FICARA DC

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	CH5976	FL

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

General Provider Information

NPI Number	:	1265438840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL ANDREW FICARA DC

Provider Business Mailing Address
First Line	:	PO BOX 814385
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33081-4385
Country	:	US
Telephone Number	:	954-920-5020
Fax Number	:	954-966-6765

Provider Business Practice Location Address
First Line	:	2500 HOLLYWOOD BLVD
Second Line	:	SUIRE 409
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6615
Country	:	US
Telephone Number	:	954-920-5020
Fax Number	:	954-966-6765

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/23/2013

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