MEDICARE: MR. JOHN ADAM COTTRELL 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	CH9073	FL

General Provider Information

NPI Number	:	1295796506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ADAM COTTRELL DC

Provider Business Mailing Address
First Line	:	8600 W STATE ROAD 84 STE C
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4558
Country	:	US
Telephone Number	:	954-424-1142
Fax Number	:	954-424-1143

Provider Business Practice Location Address
First Line	:	8600 W STATE ROAD 84 STE C
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4558
Country	:	US
Telephone Number	:	954-424-1142
Fax Number	:	954-424-1143

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/28/2012

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