MEDICARE: HSN MEDICAL GROUP 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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1366789810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HSN MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	619 8TH ST S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 8TH ST S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6701
Country	:	US
Telephone Number	:	239-287-2365
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATIE COVINGTON
Credential	:
Telephone Number	:	239-287-2365

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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Directions to “HSN MEDICAL GROUP LLC ” Practice Location

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