MEDICARE: KEYS SPINAL DECOMPRESSION

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	CH9362	AL
2	111N00000X	Chiropractor	CH7071	FL

General Provider Information

NPI Number	:	1255521266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYS SPINAL DECOMPRESSION

Provider Business Mailing Address
First Line	:	5800 OVERSEAS HWY
Second Line	:	SUITE 7
City	:	MARATHON
State	:	FL
Zip	:	33050-2735
Country	:	US
Telephone Number	:	305-743-0756
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 N ROOSEVELT BLVD
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-4533
Country	:	US
Telephone Number	:	305-295-9755
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK RICHARD FELTS
Credential	:	D.C
Telephone Number	:	305-743-0039

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	11/08/2007

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Directions to “KEYS SPINAL DECOMPRESSION ” Practice Location

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