MEDICARE: DR. RICHARD M TAKANEN 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	CH10265	FL

General Provider Information

NPI Number	:	1215236195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD M TAKANEN D.C.

Provider Business Mailing Address
First Line	:	4041 13TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6772
Country	:	US
Telephone Number	:	407-957-1337
Fax Number	:	407-957-1848

Provider Business Practice Location Address
First Line	:	4041 13TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6772
Country	:	US
Telephone Number	:	407-957-1337
Fax Number	:	407-957-1848

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	07/13/2020

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