MEDICARE: DR. MARY SEDDIQUE 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	13755	FL

General Provider Information

NPI Number	:	1417695255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY SEDDIQUE DC

Provider Business Mailing Address
First Line	:	1305 W MIDWAY RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-4144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 W MIDWAY RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-4144
Country	:	US
Telephone Number	:	772-361-4879
Fax Number	:

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

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “ DR. MARY SEDDIQUE DC” Practice Location

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