MEDICARE: DR. JUSTIN COUGH

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	CH11206	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700286697	OTHER	FL	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144631821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN COUGH

Provider Business Mailing Address
First Line	:	2871 CLAYTON CROSSING WAY
Second Line	:	SUITE 1073
City	:	OVIEDO
State	:	FL
Zip	:	32765-3426
Country	:	US
Telephone Number	:	407-542-1614
Fax Number	:	407-542-1615

Provider Business Practice Location Address
First Line	:	2871 CLAYTON CROSSING WAY
Second Line	:	SUITE 1073
City	:	OVIEDO
State	:	FL
Zip	:	32765-3426
Country	:	US
Telephone Number	:	407-542-1614
Fax Number	:	407-542-1615

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	03/23/2015

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Directions to “ DR. JUSTIN COUGH ” Practice Location

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