MEDICARE: DOUGLAS DANIEL GAGNON D.C.

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	CH8635	FL

General Provider Information

NPI Number	:	1306962378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS DANIEL GAGNON D.C.

Provider Business Mailing Address
First Line	:	14388 TANGERINE BLVD
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-5337
Country	:	US
Telephone Number	:	561-790-4475
Fax Number	:

Provider Business Practice Location Address
First Line	:	5460 N STATE ROAD 7
Second Line	:	SUITE 112
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33319-2952
Country	:	US
Telephone Number	:	954-735-3339
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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