MEDICARE: 100 PERCENT CHIROPRACTIC TAMPA 1, 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	CH10163	FL

General Provider Information

NPI Number	:	1902235732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	100 PERCENT CHIROPRACTIC TAMPA 1, LLC

Provider Business Mailing Address
First Line	:	9906 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1858
Country	:	US
Telephone Number	:	813-510-3986
Fax Number	:

Provider Business Practice Location Address
First Line	:	9906 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1858
Country	:	US
Telephone Number	:	813-510-3986
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. PEDRO ROSADO
Credential	:	D.C.
Telephone Number	:	813-510-3986

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	07/26/2023

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