MEDICARE: CAPE CORAL INJURY CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	363A00000X	Physician Assistant
3	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1093537854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CORAL INJURY CLINIC LLC

Provider Business Mailing Address
First Line	:	1260 NE 8TH ST STE 110
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-3169
Country	:	US
Telephone Number	:	239-573-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 NE 8TH ST STE 110
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-3169
Country	:	US
Telephone Number	:	239-573-7988
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	ANDREW KAMMERER
Credential	:
Telephone Number	:	317-224-7242

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

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