MEDICARE: DR. CHRIS W CHEATWOOD D.C.

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	CH5887	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350042466	OTHER	FL	RAILROAD RETIREMENT BOARD
2	CH5887	OTHER	FL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1053377275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS W CHEATWOOD D.C.

Provider Business Mailing Address
First Line	:	737 S MISSOURI AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-4737
Country	:	US
Telephone Number	:	863-680-1064
Fax Number	:	863-680-1734

Provider Business Practice Location Address
First Line	:	737 S MISSOURI AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-4737
Country	:	US
Telephone Number	:	863-680-1064
Fax Number	:	863-680-1734

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/31/2011

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