MEDICARE: EMILIO JOSE CASTRILLON SR. DC

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	CH12943	FL

General Provider Information

NPI Number	:	1982247029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIO JOSE CASTRILLON SR. DC

Provider Business Mailing Address
First Line	:	2604 CYPRESS RIDGE BLVD STE 102-A
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6311
Country	:	US
Telephone Number	:	813-560-4673
Fax Number	:	888-728-0040

Provider Business Practice Location Address
First Line	:	2604 CYPRESS RIDGE BLVD
Second Line	:	STE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6311
Country	:	US
Telephone Number	:	813-560-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	04/20/2020

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