MEDICARE: DR. JAE OH 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	CH12366	FL

General Provider Information

NPI Number	:	1548777246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAE OH D.C.

Provider Business Mailing Address
First Line	:	1805 MAGUIRE RD STE 135
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-7924
Country	:	US
Telephone Number	:	407-217-6969
Fax Number	:	407-217-6971

Provider Business Practice Location Address
First Line	:	1805 MAGUIRE RD STE 135
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-7924
Country	:	US
Telephone Number	:	407-217-6969
Fax Number	:	407-217-6971

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	03/03/2026

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