MEDICARE: 100 CHIRO ROSADO MARTIN PLLC

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

General Provider Information

NPI Number	:	1811624885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	100 CHIRO ROSADO MARTIN PLLC

Provider Business Mailing Address
First Line	:	1605 COUNTY ROAD 220 STE 165
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 COUNTY ROAD 220 STE 165
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4910
Country	:	US
Telephone Number	:	719-217-0895
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR PEDRO ROSADO
Credential	:
Telephone Number	:	813-495-4181

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	08/01/2022

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