MEDICARE: MR. ENRICO FERDICO 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	006683	NY

General Provider Information

NPI Number	:	1366563686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ENRICO FERDICO DC

Provider Business Mailing Address
First Line	:	1736 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3716
Country	:	US
Telephone Number	:	718-837-3700
Fax Number	:	718-837-0324

Provider Business Practice Location Address
First Line	:	1736 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3716
Country	:	US
Telephone Number	:	718-837-3700
Fax Number	:	718-837-0324

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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