MEDICARE: HYBRID HEALTH AND RECOVERY

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

General Provider Information

NPI Number	:	1316407398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYBRID HEALTH AND RECOVERY

Provider Business Mailing Address
First Line	:	2717 SANTA BARBARA BLVD STE 160
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 SANTA BARBARA BLVD STE 160
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4432
Country	:	US
Telephone Number	:	239-984-9984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JORDAN BLAUSTEIN
Credential	:	DC
Telephone Number	:	239-984-9984

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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Directions to “HYBRID HEALTH AND RECOVERY ” Practice Location

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