MEDICARE: CORDERO FAMILY CHIROPRACTIC

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	CH6930	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CH6930	OTHER	FL	DR. EDWIN CORDERO'S LIC.

General Provider Information

NPI Number	:	1073711719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORDERO FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3208 LANTANA RD
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-2432
Country	:	US
Telephone Number	:	561-533-3884
Fax Number	:	561-439-7348

Provider Business Practice Location Address
First Line	:	3208 LANTANA RD
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-2432
Country	:	US
Telephone Number	:	561-533-3884
Fax Number	:	561-439-7348

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. EDWIN CORDERO
Credential	:	D.C.
Telephone Number	:	561-533-3884

Provider Enumeration Date	:	07/04/2007
Last Update Date	:	04/13/2009

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