MEDICARE: DR. JACK S PASULA DC

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	CH9028	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60758	OTHER	GA	BLUE CROSS BLUE SHIELD
2	NELF9	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1235176314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK S PASULA DC

Provider Business Mailing Address
First Line	:	1883 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1401
Country	:	US
Telephone Number	:	561-483-3900
Fax Number	:	561-483-5554

Provider Business Practice Location Address
First Line	:	1883 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1401
Country	:	US
Telephone Number	:	561-483-3900
Fax Number	:	561-483-5554

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/02/2019

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