MEDICARE: HEALTHSOURCE OF NORTHWEST FLORIDA 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	CH11561	FL
2	111N00000X	Chiropractor	CH11826	FL
3	111N00000X	Chiropractor	CH12186	FL
4	111N00000X	Chiropractor	CH7205	FL
5	111N00000X	Chiropractor	CH9112	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BM255A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1104015866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSOURCE OF NORTHWEST FLORIDA LLC

Provider Business Mailing Address
First Line	:	2122 W NINE MILE RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-9464
Country	:	US
Telephone Number	:	850-473-5555
Fax Number	:	850-473-5505

Provider Business Practice Location Address
First Line	:	2122 W NINE MILE RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-9464
Country	:	US
Telephone Number	:	850-473-5555
Fax Number	:	850-473-5505

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DR. JASON D RABINOWITZ
Credential	:	DC
Telephone Number	:	850-473-5555

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	07/21/2022

Similar Medicare Providers

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1699745281 — DR. DAVID WARING FULTON D.C.
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1093976896 — SARAH MARIE MCALPINE D.O.
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32534-9464

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1538321179 — DR. CARL L. PEARSON JR. D.C.
Practice Location Address:

2122 W NINE MILE RD
PENSACOLA, FL
32534-9464

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1154778413 — DR. SAMANTHA JO JOHNSON M.D.
Practice Location Address:

2156 W NINE MILE RD
PENSACOLA, FL
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Practice Fax:

1669900171 — DR. WILLIS HARTNETT HAYMAKER DC
Practice Location Address:

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32534-9464

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Practice Fax: 850-473-5505

Directions to “HEALTHSOURCE OF NORTHWEST FLORIDA LLC ” Practice Location

Language	Start Address	Practice Location

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