MEDICARE: DR. NASLY MENENDEZ LOPEZ D.C.

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	6796	GA
2	111N00000X	Chiropractor	CH9289	FL

General Provider Information

NPI Number	:	1114035961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NASLY MENENDEZ LOPEZ D.C.

Provider Business Mailing Address
First Line	:	15497 STONEYBROOK WEST PKWY
Second Line	:	SUITE 180
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4770
Country	:	US
Telephone Number	:	407-654-9888
Fax Number	:	407-654-9886

Provider Business Practice Location Address
First Line	:	15497 STONEYBROOK WEST PKWY
Second Line	:	SUITE 180
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4770
Country	:	US
Telephone Number	:	407-654-9888
Fax Number	:	407-654-9886

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/19/2007

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