MEDICARE: INLINE CHIROPRACTIC GROUP 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88180	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1689695496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLINE CHIROPRACTIC GROUP INC

Provider Business Mailing Address
First Line	:	2740 E OAKLAND PARK BLVD
Second Line	:	SUITE 101
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1677
Country	:	US
Telephone Number	:	954-491-4437
Fax Number	:	954-491-4492

Provider Business Practice Location Address
First Line	:	2740 E OAKLAND PARK BLVD
Second Line	:	SUITE 101
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1677
Country	:	US
Telephone Number	:	954-491-4437
Fax Number	:	954-491-4492

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EVAN JAY SLATKIN
Credential	:	D.C.
Telephone Number	:	954-491-4437

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/09/2016

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Directions to “INLINE CHIROPRACTIC GROUP INC ” Practice Location

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