MEDICARE: TARTACK CHIROPRACTIC & WELLNESS CENTER INC

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	CH0008769	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104038066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARTACK CHIROPRACTIC & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	1222 S ANDREWS AVE
Second Line	:	SUITE 501
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1806
Country	:	US
Telephone Number	:	954-764-4042
Fax Number	:	954-764-7275

Provider Business Practice Location Address
First Line	:	1222 S ANDREWS AVE
Second Line	:	SUITE 501
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1806
Country	:	US
Telephone Number	:	954-764-4042
Fax Number	:	954-764-7275

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY S TARTACK
Credential	:	D.C.
Telephone Number	:	954-764-4042

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/16/2015

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