MEDICARE: DR. DAVID ALLEN INDERWIESEN DC

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	CH5802	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	22661	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1154489326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALLEN INDERWIESEN DC

Provider Business Mailing Address
First Line	:	11905 E COLONIAL DRIVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4725
Country	:	US
Telephone Number	:	407-281-0900
Fax Number	:	407-281-0900

Provider Business Practice Location Address
First Line	:	12484 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7100
Country	:	US
Telephone Number	:	407-281-0900
Fax Number	:	407-281-0900

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	10/19/2015

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