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General NPI Number Information
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NPI Number | 1447363882
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Entity Type | Organization
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Legal Business Name | SAN CARLOS CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 19150 ACORN ROAD SUITE 103
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City | FORT MYERS
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State | FL
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Zip | 33967-3657
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Country | US
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Telephone | 239-267-3133
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Fax | 239-267-8032
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Provider Business Mailing Address
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Address Line | 19150 ACORN ROAD SUITE 103
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City | FORT MYERS
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State | FL
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Zip | 33967-3657
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Country | US
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Telephone | 239-267-3133
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Fax | 239-267-8032
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. GLEN SCHAFFER
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Credential | DC
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Telephone | 239-267-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0004195
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License Number State | FL
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