MEDICARE: DEER CREEK WELLNESS CENTER INC

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 7967	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53892	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538581624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER CREEK WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	107 N POWERLINE RD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-8037
Country	:	US
Telephone Number	:	954-428-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 N POWERLINE RD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-8037
Country	:	US
Telephone Number	:	954-428-0225
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JAMES EWING
Credential	:	D.C.
Telephone Number	:	954-428-0225

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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