MEDICARE: DIEGO FERNANDO JATIVA 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	CH7151	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197020	OTHER	FL	CHIRO ALLIANCE CORP.
2	109233	OTHER	FL	AMERIGROUP
3	53968	OTHER	FL	BLUE CROSS BLUE SHIELD
4	7443014	OTHER	FL	AETNA
5	9705808	OTHER	FL	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578625323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEGO FERNANDO JATIVA D.C.

Provider Business Mailing Address
First Line	:	2467 E SEMORAN BLVD
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5806
Country	:	US
Telephone Number	:	407-814-0985
Fax Number	:	407-814-0119

Provider Business Practice Location Address
First Line	:	535 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7801
Country	:	US
Telephone Number	:	407-277-1031
Fax Number	:	407-277-5556

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	03/27/2014

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Directions to “ DIEGO FERNANDO JATIVA D.C.” Practice Location

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