MEDICARE: DR. MARK J GANS 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	CH0002527	FL

General Provider Information

NPI Number	:	1205992161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J GANS D.C.

Provider Business Mailing Address
First Line	:	2045 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3936
Country	:	US
Telephone Number	:	954-746-8887
Fax Number	:	954-746-2159

Provider Business Practice Location Address
First Line	:	2045 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3936
Country	:	US
Telephone Number	:	954-746-8887
Fax Number	:	954-746-2159

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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