MEDICARE: FERNCREEK HEALING CENTER, LLC

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	CH9300	FL

General Provider Information

NPI Number	:	1881030591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNCREEK HEALING CENTER, LLC

Provider Business Mailing Address
First Line	:	1600 E MARKS ST
Second Line	:	SUITE B
City	:	ORLANDO
State	:	FL
Zip	:	32803-4156
Country	:	US
Telephone Number	:	407-228-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E MARKS ST
Second Line	:	SUITE B
City	:	ORLANDO
State	:	FL
Zip	:	32803-4156
Country	:	US
Telephone Number	:	407-228-8228
Fax Number	:

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	JODI L RICE
Credential	:	D.C.
Telephone Number	:	407-228-8228

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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