MEDICARE: DR. DARREN LASTOFSKY D.C.

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	CH6544	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	:	1306858279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARREN LASTOFSKY D.C.

Provider Business Mailing Address
First Line	:	5315 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3353
Country	:	US
Telephone Number	:	561-434-4900
Fax Number	:	561-434-4934

Provider Business Practice Location Address
First Line	:	5315 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3353
Country	:	US
Telephone Number	:	561-434-4900
Fax Number	:	561-434-4934

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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