MEDICARE: GEN TRIO, PA

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	CH10339	FL

General Provider Information

NPI Number	:	1225433782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEN TRIO, PA

Provider Business Mailing Address
First Line	:	9654 W LINEBAUGH AVE
Second Line	:	SUITE 117
City	:	TAMPA
State	:	FL
Zip	:	33626-1805
Country	:	US
Telephone Number	:	813-344-4499
Fax Number	:

Provider Business Practice Location Address
First Line	:	9654 W LINEBAUGH AVE
Second Line	:	SUITE 117
City	:	TAMPA
State	:	FL
Zip	:	33626-1805
Country	:	US
Telephone Number	:	813-344-4499
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNY L MEJIA
Credential	:	DC
Telephone Number	:	813-344-4499

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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Directions to “GEN TRIO, PA ” Practice Location

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