MEDICARE: JOSE J MAURICIO 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	CH2735	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5169160	OTHER	FL	AETNA
2	173908	OTHER	FL	CHIRO ALLIANCE CORP
3	8369250	OTHER	FL	CIGNA
4	229026	OTHER	FL	AMERIGROUP

General Provider Information

NPI Number	:	1356401525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE J MAURICIO D.C.

Provider Business Mailing Address
First Line	:	4747 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1245
Country	:	US
Telephone Number	:	407-240-8430
Fax Number	:	407-438-8905

Provider Business Practice Location Address
First Line	:	4747 S CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1245
Country	:	US
Telephone Number	:	407-240-8430
Fax Number	:	407-438-8905

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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