MEDICARE: FOUR CORNERS CHIROPRACTIC CENTERS PA

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	CH8554	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89280	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1619963147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR CORNERS CHIROPRACTIC CENTERS PA

Provider Business Mailing Address
First Line	:	PO BOX 135818
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34713-5818
Country	:	US
Telephone Number	:	352-394-7771
Fax Number	:	352-394-7784

Provider Business Practice Location Address
First Line	:	1050 US HIGHWAY 27
Second Line	:	SUITE 7
City	:	CLERMONT
State	:	FL
Zip	:	34714-7508
Country	:	US
Telephone Number	:	352-394-7771
Fax Number	:	352-394-7784

Authorized Official
Title or Position	:	PRESIDENT/OWNER/CHIROPRACTOR
Name	:	SCOTT DAVID BARNHART
Credential	:	DC
Telephone Number	:	352-394-7771

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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Directions to “FOUR CORNERS CHIROPRACTIC CENTERS PA ” Practice Location

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