MEDICARE: LEGAULT CHIROPRACTIC HEALTH CENTER

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	CH0002573	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45822	OTHER	FL	BCBS GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467657619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGAULT CHIROPRACTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	5745 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6326
Country	:	US
Telephone Number	:	954-966-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6326
Country	:	US
Telephone Number	:	954-966-2211
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. JACQUELINE LEGAULT VALCOURT
Credential	:	DC
Telephone Number	:	954-966-2211

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/22/2020

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