MEDICARE: MIND, BODY AND SPIRIT CHIROPRACTIC, INC.

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	CH8243	FL

General Provider Information

NPI Number	:	1326228495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND, BODY AND SPIRIT CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	6220 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1904
Country	:	US
Telephone Number	:	954-489-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1904
Country	:	US
Telephone Number	:	954-489-9773
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE LOUIS ORTA
Credential	:	D.C.
Telephone Number	:	954-489-4790

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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