MEDICARE: SOROKA STARBUCK PA DBA FAMILY CHIROPRACTIC CENTER

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	CH5044	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255526109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOROKA STARBUCK PA DBA FAMILY CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	35 CLAYTON LN
Second Line	:	SUITE A
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5781
Country	:	US
Telephone Number	:	850-231-0211
Fax Number	:	850-231-6006

Provider Business Practice Location Address
First Line	:	35 CLAYTON LN
Second Line	:	SUITE A
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5781
Country	:	US
Telephone Number	:	850-231-0211
Fax Number	:	850-231-6006

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	DR. BRIAN KEITH SOROKA
Credential	:	D.C.
Telephone Number	:	850-231-2011

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/27/2007

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