MEDICARE: ADVANCED CHIROPRACTIC OF HAINES CITY, LLC

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	:	1053598326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC OF HAINES CITY, LLC

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

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

Authorized Official
Title or Position	:	MANAGER
Name	:	LINDA RICH-CONSIGLIO
Credential	:	D.C.
Telephone Number	:	954-649-2327

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/29/2008

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