MEDICARE: HERON LAKES CHIROPRACTIC CENTER

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	CH8680	FL
2	111N00000X	Chiropractor	CH8773	FL

General Provider Information

NPI Number	:	1114143278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERON LAKES CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	5675 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3124
Country	:	US
Telephone Number	:	954-341-2256
Fax Number	:	954-341-2264

Provider Business Practice Location Address
First Line	:	5675 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3124
Country	:	US
Telephone Number	:	954-341-2256
Fax Number	:	954-341-2264

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JARED STEPHAN COHEN
Credential	:	D.C.
Telephone Number	:	954-341-2256

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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