MEDICARE: DR. JACOB ROY HARDEN 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	CH 11495	FL

General Provider Information

NPI Number	:	1174918205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB ROY HARDEN D.C.

Provider Business Mailing Address
First Line	:	1325 S INTERNATIONAL PKWY
Second Line	:	SUITE 1221
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1695
Country	:	US
Telephone Number	:	817-694-1433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S INTERNATIONAL PKWY
Second Line	:	SUITE 1221
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1695
Country	:	US
Telephone Number	:	817-694-1433
Fax Number	:

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

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/06/2015

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