MEDICARE: DR. JONATHON RICHARD NOWAKOWSKI 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	CH-12660	FL

General Provider Information

NPI Number	:	1306479753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHON RICHARD NOWAKOWSKI DC

Provider Business Mailing Address
First Line	:	12231 E COLONIAL DR STE 110
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4759
Country	:	US
Telephone Number	:	321-204-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	12231 E COLONIAL DR STE 110
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4759
Country	:	US
Telephone Number	:	321-204-2610
Fax Number	:

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

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/13/2020

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