MEDICARE: DANIEL DICRISTOFARO 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	CHOO6526	FL

General Provider Information

NPI Number	:	1356449151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DICRISTOFARO D.C.

Provider Business Mailing Address
First Line	:	5884 MICHAUX ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7276
Country	:	US
Telephone Number	:	561-361-4377
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6042
Country	:	US
Telephone Number	:	954-582-9797
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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