MEDICARE: BACK2NATURE CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1164999124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK2NATURE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	14040 CHICORA CROSSING BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7744
Country	:	US
Telephone Number	:	313-574-3034
Fax Number	:

Provider Business Practice Location Address
First Line	:	14040 CHICORA CROSSING BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7744
Country	:	US
Telephone Number	:	313-574-3034
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADDISON O'DAY
Credential	:	DC
Telephone Number	:	313-574-3034

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/29/2018

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