MEDICARE: LOVING CHIROPRACTIC AND WELLNESS 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	261QP2000X	Physical Therapy Clinic/Center	PT5764	FL
2	111N00000X	Chiropractor	CH8004	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88234	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1871762104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING CHIROPRACTIC AND WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	630 SE MONTEREY RD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4410
Country	:	US
Telephone Number	:	772-219-3313
Fax Number	:	772-219-3314

Provider Business Practice Location Address
First Line	:	630 SE MONTEREY RD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4410
Country	:	US
Telephone Number	:	772-219-3313
Fax Number	:	772-219-3314

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MARK HAMMOND LOVING
Credential	:	MSPT,DC
Telephone Number	:	772-219-3313

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	05/19/2008

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