MEDICARE: THE LAKOTA MEDICAL

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	111NN1001X	Nutrition Chiropractor	CH-9136	FL

General Provider Information

NPI Number	:	1790959518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LAKOTA MEDICAL

Provider Business Mailing Address
First Line	:	3200 S HIAWASSEE RD
Second Line	:	SUITE 203
City	:	ORLANDO
State	:	FL
Zip	:	32835-6317
Country	:	US
Telephone Number	:	407-253-0800
Fax Number	:	407-253-0806

Provider Business Practice Location Address
First Line	:	3200 S HIAWASSEE RD
Second Line	:	SUITE 203
City	:	ORLANDO
State	:	FL
Zip	:	32835-6317
Country	:	US
Telephone Number	:	407-253-0800
Fax Number	:	407-253-0806

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. ELYSE SALTALAMACHIA
Credential	:	DC
Telephone Number	:	407-253-0800

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	06/03/2008

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Directions to “THE LAKOTA MEDICAL ” Practice Location

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