MEDICARE: MARION CHIROPRACTIC ASSOCIATES P A

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	CH8370	FL

General Provider Information

NPI Number	:	1942392824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION CHIROPRACTIC ASSOCIATES P A

Provider Business Mailing Address
First Line	:	7133 SE MARICAMP RD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34472-2103
Country	:	US
Telephone Number	:	352-680-0031
Fax Number	:	352-680-1288

Provider Business Practice Location Address
First Line	:	7133 SE MARICAMP RD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34472-2103
Country	:	US
Telephone Number	:	352-680-0031
Fax Number	:	352-680-1288

Authorized Official
Title or Position	:	PRESIDENT CHIROPRACTIC PHYSICIAN
Name	:	DR. LESLIE JAMES VAZOULAS
Credential	:	D.C
Telephone Number	:	353-817-3783

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	09/19/2007

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