MEDICARE: GALT MILE WELLNESS CHIROPRACTIC 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	CH8404	FL

General Provider Information

NPI Number	:	1669640181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALT MILE WELLNESS CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	3320 NE 34TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-564-3200
Fax Number	:	954-564-3201

Provider Business Practice Location Address
First Line	:	3320 NE 34TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6906
Country	:	US
Telephone Number	:	954-564-3200
Fax Number	:	954-564-3201

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. HARRIETTA CECCARELLI
Credential	:	D.C.
Telephone Number	:	954-564-3200

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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