MEDICARE: DR. AMY SUZANNE OUELLETTE 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	CH8246	FL

General Provider Information

NPI Number	:	1356377881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY SUZANNE OUELLETTE DC

Provider Business Mailing Address
First Line	:	9710 STIRLING RD
Second Line	:	112
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8018
Country	:	US
Telephone Number	:	954-392-7700
Fax Number	:	954-392-7711

Provider Business Practice Location Address
First Line	:	9710 STIRLING RD
Second Line	:	112
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8018
Country	:	US
Telephone Number	:	954-392-7700
Fax Number	:	954-392-7711

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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