MEDICARE: MR. EVENS VILSAINT

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	111NR0400X	Rehabilitation Chiropractor		FL

General Provider Information

NPI Number	:	1073632436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EVENS VILSAINT

Provider Business Mailing Address
First Line	:	1809 S KIRKMAN RD APT 1623
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2322
Country	:	US
Telephone Number	:	407-253-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	6903 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6829
Country	:	US
Telephone Number	:	407-253-0333
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	04/08/2008

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