MEDICARE: SUMMERLIN CIROPRACTIC, 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

General Provider Information

NPI Number	:	1972773299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERLIN CIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	15880 SUMMERLIN RD STE 107
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9614
Country	:	US
Telephone Number	:	239-432-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	15880 SUMMERLIN RD STE 107
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9614
Country	:	US
Telephone Number	:	239-432-0900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES DAREN FITZPATRICK
Credential	:	D.C.
Telephone Number	:	239-432-0900

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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