MEDICARE: WEST WIND CHIROPRACTIC LLC

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	CH11238	FL

General Provider Information

NPI Number	:	1306251293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST WIND CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	14090 METROPOLIS AVE
Second Line	:	STE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4450
Country	:	US
Telephone Number	:	239-431-9432
Fax Number	:

Provider Business Practice Location Address
First Line	:	14090 METROPOLIS AVE
Second Line	:	STE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4450
Country	:	US
Telephone Number	:	239-431-9432
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN KEITH PADGETT
Credential	:	DC
Telephone Number	:	239-431-9432

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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