MEDICARE: ADVANCED CHIROPRACTIC OF PALM HARBOR P.A.

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	CH9313	FL

General Provider Information

NPI Number	:	1306021381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC OF PALM HARBOR P.A.

Provider Business Mailing Address
First Line	:	9555 SEMINOLE BLVD
Second Line	:	SUITE 207
City	:	SEMINOLE
State	:	FL
Zip	:	33772-2562
Country	:	US
Telephone Number	:	727-596-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	9555 SEMINOLE BLVD
Second Line	:	SUITE 207
City	:	SEMINOLE
State	:	FL
Zip	:	33772-2562
Country	:	US
Telephone Number	:	727-596-4878
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN/PRESIDENT
Name	:	DR. SEAN L SHARP
Credential	:	D.C.
Telephone Number	:	727-424-0187

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	11/10/2010

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