MEDICARE: ADVANCE CHIROPRACTIC ADJUSTMENT, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC7316	OTHER	FL	HEALTH CARE CLINIC

General Provider Information

NPI Number	:	1992911200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CHIROPRACTIC ADJUSTMENT, INC.

Provider Business Mailing Address
First Line	:	3643 WIMBLEDON LN
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8698
Country	:	US
Telephone Number	:	863-521-0677
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 PATTERSON RD STE 2
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6261
Country	:	US
Telephone Number	:	863-421-8687
Fax Number	:	863-421-8670

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ANNE-RUTHE MERCIER
Credential	:
Telephone Number	:	863-521-0677

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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